Clinical Outcomes of Different Stroke Prevention Strategies in Patients With Inadvertent Left Atrial Appendage Electrical Isolation.

BACKGROUND

Inadvertent left atrial appendage electrical isolation (LAAEI) during persistent atrial fibrillation (AF) ablation increases thromboembolic risk. The optimal antithrombotic strategy for these patients remains unclear.

OBJECTIVES

This study aimed to compare the safety and efficacy of left atrial appendage closure (LAAC) performed within 3 months after catheter ablation versus long-term postoperative received direct oral anticoagulants (DOACs) in patients with persistent AF who experienced inadvertent LAAEI during catheter ablation.

METHODS

The single-center retrospective analysis included 225 patients with inadvertent LAAEI during persistent AF ablation between January 2019 and March 2024. After propensity score matching (PSM), 144 patients were analyzed: 72 received LAAC (LAAC group), and 72 received DOACs (DOAC group). Outcomes, including bleeding and thromboembolic events, were assessed over a mean follow-up of 827 days.

RESULTS

The LAAC group had significantly fewer non-procedure-related major and clinically relevant nonmajor bleeding events compared to the DOAC group (HR = 0.417, 95% CI: 0.181-0.960, p = 0.034). Thromboembolic events were similar (HR = 0.246, 95% CI: 0.071-0.851, p = 0.205). Atrial arrhythmia recurrence rates were comparable (HR = 0.939, 95% CI: 0.587-1.502, p = 0.054). Normal LAA function was observed in 41.67% of the DOAC group, while the LAAC group had two cases of device-related thrombus resolved with anticoagulation.

CONCLUSIONS

LAAC within 3 months after catheter ablation may reduce bleeding risk while maintaining efficacy comparable to long-term DOACs in patients with inadvertent LAAEI. LAAC represents a safe and effective strategy for this population.