Safety and Efficacy of Left Atrial Ablation After Percutaneous Left Atrial Appendage Occlusion in High-Bleeding-Risk Patients with Atrial Fibrillation: A Multicenter Analysis from the PROCEED-AF Ablation Registry
Abstract
BACKGROUND AND AIMS: Patients with left atrial appendage (LAAO) devices are increasingly referred for AF ablation, yet anticoagulation strategies remain uncertain. The goal of this study was to evaluate the safety and efficacy of catheter ablation for atrial fibrillation (AF) in patients with pre-existing LAAO devices and to describe patterns in anticoagulation management after ablation in this unique population. METHODS: We collected data from 14 centers worldwide on patients with prior LAAO devices undergoing AF ablation. Each site provided clinical characteristics, procedural details, and information on complications and arrhythmia outcomes. Data were aggregated and analyzed centrally to evaluate procedural safety, efficacy, and variability in management strategies. RESULTS: A total of 198 patients (age 70 years, 37% female, 42% paroxysmal AF) with prior LAAO were included. Ablation was performed a median of 271 days after LAAO. After ablation, 84% of patients were on oral anticoagulation (OAC), most commonly for 2-3 months. Bleeding complications on OAC occurred in 6.7% of patients at a median of 20 (13, 70) days after ablation. Stroke or TIA occurred in 5 patients (2.6% of cases) within the follow-up period with 2 occurrences (1% of cases) the day after ablation. There were 2 cases of new or worsened peri-device leak after ablation. CONCLUSION: In a large, international registry of patients undergoing catheter ablation for AF with pre-existing LAAO devices, ablation was feasible and device related complications were rare Despite higher bleeding risk in an LAAO population, 84% of patients with prior LAAO tolerated short term OAC post-ablation with bleeding events at expected rates for this population.
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Authors: Rachel M. Kaplan, Jeanne du Fay de Lavallaz, Christian‐Hendrik Heeger, Hakan Oral, Mason Yoder, David Schaack, K. R. Julian Chun, Boris Schmidt, Jeffrey Winterfield, William H. Sauer, Fernando Moreno, Jonathan W. Waks, Antonio Dello Russo, Paolo Compagnucci, Pipin Kojodjojo, Ghanshyam Shantha, Laurent Roten, Tobias Reichlin, Thomas Kueffer, Kenneth Brownell, Smit C Vasaiwala, Timothy M. Markman, Patrick Badertscher, Michael Kühne, Christian Sticherling, Nishant Verma, Graham Peigh, Bradley P. Knight, Tom J. R. De Potter, Konstantia Paraskevi Gkini, Dhiraj Gupta, Mark T Mills, Serge Bovéda, Robin Richard-Vitton, Jorge E. Romero, Fengxiang Zhang, Raktham Mekritthikrai, Henry D Huang
Institutions: Brigham and Women's Hospital, University of Pennsylvania, University of Chicago, Northwestern University, University of Liverpool, University of Michigan, Wuhan University, Northwestern University, Nanjing Medical University, University of Bern, California University of Pennsylvania, University of Lübeck, University Hospital of Bern, Beth Israel Deaconess Medical Center, Medical University of South Carolina, Loyola University Medical Center, Wake Forest University, Rush University Medical Center, Wuhan Asia Heart Hospital, SUNY Upstate Medical University, National Heart Centre Singapore, Ospedali Riuniti Umberto I, Onze Lieve Vrouwziekenhuis Hospital, Clinique Pasteur, Hospital Base, Cardiovascular Center Frankfurt, Cardiovascular Center Bethanien