Efficacy and safety of concomitant left atrial appendage closure and pulmonary vein isolation compared to left atrial appendage closure only – A meta-analysis

Abstract

Background Atrial fibrillation (AF) is associated with an increased risk of ischemic stroke, primarily originating from the left atrial appendage (LAA). Percutaneous LAA closure (LAAC) reduces appendage-borne thromboembolism, while pulmonary vein isolation (PVI) restores sinus rhythm. Observational data on the combined one-stop procedure are heterogeneous, and data on its risk-benefit profile remain scarce. Thus, a meta-analysis was performed to compare the efficacy and safety of combined LAAC+PVI versus LAAC-only. Methods A structured systematic search of PubMed, MEDLINE, Scopus and Web of Science was performed for studies comparing outcomes of AF patients undergoing combined LAAC+PVI or LAAC-only. Results Fifteen studies reporting data from 335,013 patients (11,839 LAAC+PVI; 323,174 LAAC-only) were included. Combined LAAC+PVI was associated with significantly fewer systemic thromboembolisms at follow-up (OR = 0.76, 95% CI = 0.60–0.96, I 2 = 1%) compared to LAAC-only. However, periprocedural pericardial effusion requiring drainage was significantly more frequent in the combined group (OR = 1.72, 95% CI = 1.26–2.34, I 2 = 0%). Peri-device leaks were significantly less common immediately post-procedure (OR = 0.57, 95% CI = 0.35–0.92, I 2 = 19%), but significantly more frequent on follow-up echocardiography (OR = 1.56, 95% CI = 1.14–2.12, I 2 = 71%). Mortality, major bleeding, device-related thrombus, and pericardial effusion without drainage did not differ significantly between groups. Conclusion Combined LAAC+PVI was associated with fewer systemic thromboembolisms than LAAC-only, but a higher periprocedural risk of pericardial effusion requiring drainage and divergent temporal behaviour of peri-device leaks. Randomized controlled trials are warranted to confirm these findings.