Combination of ablation and left atrial appendage closure as "One-stop" procedure in the treatment of atrial fibrillation: Current status and future perspective

Ben He, Li-Sheng Jiang, Zi-Yong Hao, Hao Wang, Yu-Tong Miao, Ben He, Li-Sheng Jiang, Zi-Yong Hao, Hao Wang, Yu-Tong Miao

Abstract

Atrial fibrillation (AF), the most common arrhythmia, is a major cause of stroke and systemic embolism. Left atrial appendage closure (LAAC) has been proved to be noninferior to traditional Vitamin K antagonists (VKAs) as well as novel oral anticoagulants (NOACs), which is becoming an important alternative to prevent stroke in non-valvular AF. Catheter-based AF ablation (CA) is recommended to be a standard of care in patients with AF refractory to drug therapy due to a better rhythm control and improvement of life quality than antiarrhythmic drugs. Theoretically, the one-stop combination with LAAC and CA tends to bring more benefits in patients with AF, as it not only relieves symptoms, but also reduces the risk of stroke significantly. However, several important questions still need to be considered in the combination procedure although quite a few attempts have already been made in clinical practice. This review provides a comprehensive update on the concept, technique, perioperative management, benefits and other critical issues of the "one-stop" procedure.

Keywords: atrial fibrillation; catheter ablation; efficacy; left atrial appendage closure; safety; stroke.

Conflict of interest statement

The authors declare no conflict of interest.

© 2021 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.

Figures

FIGURE 1
FIGURE 1
Clinical decision making in selection of AF procedures according to LA size and CHA2DS2‐VASc Score. The higher the CHA2DS2‐VASc score and the larger LA size, the more benefit from LAAC, while the lower the CHA2DS2‐VASc score and the smaller LA size, the more benefit from PVI. Abbreviations: LA, left atrium; LAAC, left atrial appendage closure; PVI, pulmonary vein isolation
FIGURE 2
FIGURE 2
Relationship between AF type and CHA2DS2‐VASc Score in published “one‐stop procedure” studies. In patients underwent the one‐stop procedure with catheter ablation and left atrial appendage closure, the proportion of persistent or long‐standing persistent AF patients is 30%−60%
FIGURE 3
FIGURE 3
Relationship between Age and CHA2DS2‐VASc Score in published “one‐stop procedure” studies. Most of the involved patients underwent the one‐stop combination procedure with catheter ablation and left atrial appendage closure are between 62 to 68 years old with CHA2DS2‐VASc scores ≥2

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