The safety and efficacy of a combined approach of catheter ablation (CA) and left atrial appendage occlusion (LAAO) compared to LAAO alone remain unknown. Patients with atrial fibrillation (AF) at increased stroke risk who underwent LAAO were divided into either combined (CA and LAAO) procedures or LAAO alone group. Propensity score matching was utilized to balance baseline characteristics. The primary endpoint of the study was a composite of death, thromboembolic events, major bleeding, heart failure (HF) rehospitalization, and major periprocedural complications. A total of 707 AF patients who underwent LAAO were included. After 1:1 propensity score matching, 166 patients who underwent LAAO alone (n = 83) or the combined procedure (n = 83) were analyzed. Successful LAAO was achieved in all (100%) patients, with a low incidence of periprocedural complications in both groups (2.4% vs. 4.8%, LAAO vs. combined, p = 0.68). The incidence of peri-device leak post-LAAO was significantly higher in the combined group (25.3% vs. 43.4%, p = 0.01). After a median follow-up of 2 years, there were no significant differences in the rates of the primary composite endpoint between the two strategies (22.2% vs. 14.3%, HR: 1.24 [95% CI: 0.51–2.97], p = 0.63). However, the rate of HF rehospitalization was significantly lower in the combined group (19.6% vs. 3.6%, HR: 4.89 [95% CI: 1.50–15.97], p = 0.024). Combining CA and LAAO in a “one-stop” approach is safe and brings additional benefits in relieving symptoms of heart failure, although peri-device leak was more common compared to LAAO alone.

中文翻译：

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导管消融和左心耳封堵相结合治疗高危房颤患者：倾向评分匹配分析

与单独使用 LAAO 相比，导管消融 (CA) 和左心耳封堵 (LAAO) 联合治疗的安全性和有效性仍不清楚。接受 LAAO 治疗的中风风险增加的心房颤动 (AF) 患者被分为联合手术（CA 和 LAAO）或单独 LAAO 组。利用倾向评分匹配来平衡基线特征。该研究的主要终点是死亡、血栓栓塞事件、大出血、心力衰竭（HF）再住院和主要围手术期并发症的复合终点。总共纳入了 707 名接受 LAAO 的 AF 患者。经过 1:1 倾向评分匹配后，对 166 名接受单独 LAAO (n = 83) 或联合手术 (n = 83) 的患者进行了分析。所有 (100%) 患者均获得成功的 LAAO，两组围手术期并发症的发生率均较低（2.4% vs. 4.8%，LAAO vs. 联合治疗，p = 0.68）。联合组中 LAAO 后装置周围泄漏的发生率显着较高（25.3% vs. 43.4%，p = 0.01）。中位随访 2 年后，两种策略之间的主要复合终点发生率没有显着差异（22.2% vs. 14.3%，HR：1.24 [95% CI：0.51–2.97]，p = 0.63）。然而，合并组的心力衰竭再住院率显着较低（19.6% vs. 3.6%，HR：4.89 [95% CI：1.50–15.97]，p = 0.024）。尽管与单独使用 LAAO 相比，装置周围渗漏更常见，但以“一站式”方法结合 CA 和 LAAO 是安全的，并且在缓解心力衰竭症状方面带来了额外的好处。