New analysis links combined heart procedures to more rhythm recurrences
Across 14 studies, the combined approach was associated with more recurrent abnormal rhythms, while a key heart-fluid complication did not differ significantly.
High evidenceReviewSome caution advised
Medical disclaimer: This article summarizes research findings and is for informational purposes only. It is not medical advice.
Editorial illustration — not from the study.
Researchers combined results from 14 studies comparing catheter ablation alone with a single procedure that combined catheter ablation and closure of the left atrial appendage. These procedures are used in people with atrial fibrillation, an irregular heart rhythm associated with stroke risk.
Arrhythmia recurrence was more common in the combined-procedure group, and the combined procedure took slightly longer on average. The review found no statistically significant difference between groups in drainage-requiring fluid around the heart or systemic thromboembolism, but the findings need confirmation in randomized trials.
What the review covered
The researchers performed a systematic review and meta-analysis of studies indexed in PubMed, Scopus, and Web of Science through June 12, 2026. They compared combined catheter ablation plus percutaneous left atrial appendage closure with catheter ablation alone in people with atrial fibrillation. The 14 included studies involved 3,274 people: 1,505 received the combined procedure and 1,769 received catheter ablation alone. The main outcomes were recurrence of an abnormal heart rhythm and pericardial effusion requiring drainage.
What the evidence shows
Arrhythmia recurrence was significantly more frequent after combined catheter ablation and left atrial appendage closure than after catheter ablation alone: odds ratio 1.56, with a 95% confidence interval of 1.11 to 2.19. This is an association from pooled studies and does not by itself show that combining the procedures caused the additional recurrences.
Systemic thromboembolism was numerically lower with the combined procedure, but the difference was not statistically significant: odds ratio 0.66, 95% confidence interval 0.37 to 1.21. Total procedure time was about 9.34 minutes longer on average with the combined approach. Pericardial effusion requiring drainage, meaning fluid around the heart that needed a drainage procedure, did not differ significantly: odds ratio 1.19, 95% confidence interval 0.59 to 2.44.
Where this may apply
These findings may be relevant to adults with atrial fibrillation who are being considered for catheter ablation, with or without closure of the left atrial appendage, if they are similar to the people included in the reviewed studies. They do not establish what will happen to every patient, and they should not be interpreted as advice about which procedure to choose.
Why it matters
Catheter ablation aims to control atrial fibrillation, while left atrial appendage closure is intended to address a major source of clot formation associated with this rhythm disorder. The analysis suggests that performing both procedures together was associated with more rhythm recurrences than catheter ablation alone, without a statistically significant difference in the studied drainage-requiring heart-fluid complication. It also highlights that the balance of rhythm outcomes, clot-related outcomes, procedure time, and complications remains uncertain and requires better comparative research. These results describe groups in published human studies and do not predict outcomes for every individual patient or settle which approach is appropriate.
Limitations & evidence assessment
The review combined 14 studies, but the abstract does not provide enough information about each study's design, follow-up period, or patient characteristics. The need for randomized controlled trials means differences between the groups may have influenced the results, so the analysis shows an association rather than proving that the combined procedure caused more recurrences. Results for some outcomes also varied substantially between studies, especially procedure time. The review found no statistically significant difference in systemic blood clots or drainage-requiring fluid around the heart, but these results may be limited by the number and size of the studies.
Why this evidence level: Meta-analysis pooling multiple studies sits at the top of common evidence hierarchies.
Evidence levels are editorial estimates derived from study metadata — they are not clinical appraisals.
// Source
Journal of Interventional Cardiac Electrophysiology · 2026 · DOI: 10.1007/s10840-026-02418-3
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