TY - JOUR
T1 - Concurrent percutaneous left atrial appendage occlusion and catheter ablation for atrial fibrillation: State-of-the-art review.
AU - Mills, Mark T.
AU - Calvert, Peter
AU - Velavan, Periaswamy
AU - Lip, Gregory Y. H.
AU - Gupta, Dhiraj
PY - 2023/11/21
Y1 - 2023/11/21
N2 - Stroke prevention and symptom control are two integral pillars in atrial fibrillation (AF) management. Percutaneous left atrial appendage occlusion (LAAO) is effective at reducing stroke risk in high-risk patients with AF who cannot tolerate oral anticoagulant therapy, whilst catheter ablation is effective at reducing AF burden and improving quality-of-life in patients who remain symptomatic despite medical therapy. If both procedures are indicated in an individual patient, they have traditionally been performed on separate occasions, due to long cumulative procedural times, itself associated with thromboembolic risk. Recently, with the advancement of procedural techniques, the concept of concurrent LAAO and AF catheter ablation has gained traction. This review summarises the evidence for and against concurrent LAAO and AF catheter ablation, discussing procedural considerations, including procedural sequencing and post-procedural antithrombotic therapy, safety and efficacy outcomes, and future directions in the field.
AB - Stroke prevention and symptom control are two integral pillars in atrial fibrillation (AF) management. Percutaneous left atrial appendage occlusion (LAAO) is effective at reducing stroke risk in high-risk patients with AF who cannot tolerate oral anticoagulant therapy, whilst catheter ablation is effective at reducing AF burden and improving quality-of-life in patients who remain symptomatic despite medical therapy. If both procedures are indicated in an individual patient, they have traditionally been performed on separate occasions, due to long cumulative procedural times, itself associated with thromboembolic risk. Recently, with the advancement of procedural techniques, the concept of concurrent LAAO and AF catheter ablation has gained traction. This review summarises the evidence for and against concurrent LAAO and AF catheter ablation, discussing procedural considerations, including procedural sequencing and post-procedural antithrombotic therapy, safety and efficacy outcomes, and future directions in the field.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Cryoablation
KW - Left atrial appendage occlusion
KW - Pulsed field ablation
KW - Radiofrequency
UR - http://www.scopus.com/inward/record.url?scp=85181810917&partnerID=8YFLogxK
U2 - 10.1016/j.tcm.2023.11.003
DO - 10.1016/j.tcm.2023.11.003
M3 - Review article
SN - 1050-1738
JO - Trends in Cardiovascular Medicine
JF - Trends in Cardiovascular Medicine
ER -