IMR Press / RCM / Volume 25 / Issue 1 / DOI: 10.31083/j.rcm2501010
Open Access Original Research
Insufficient Ablation is Associated with Atrial Fibrillation Recurrence after Combining Ablation and Left Atrial Appendage Closure
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1 Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016 Hangzhou, Zhejiang, China
2 Department of Cardiovasology, Changhai Hospital, Second Military Medical University, 200433 Shanghai, China
*Correspondence: guozhifu@126.om (Zhifu Guo); huangsongqun@hotmail.com (Songqun Huang)
These authors contributed equally.
Rev. Cardiovasc. Med. 2024, 25(1), 10; https://doi.org/10.31083/j.rcm2501010
Submitted: 21 July 2023 | Revised: 21 August 2023 | Accepted: 25 August 2023 | Published: 9 January 2024
Copyright: © 2024 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: The combination of left atrial appendage closure (LAAC) and catheter ablation (CA) in a single procedure is a safe and effective form of treatment for atrial fibrillation (AF). However, several findings have argued that LAAC might increase the risk of AF recurring. Therefore, this study investigated the impact of insufficient ablation on AF recurrence after the hybrid procedures of CA and LAAC. Methods: We reviewed 107 consecutive patients with AF who received the CA and LAAC hybrid procedures (combined group). In the case–control study, another 107 patients who underwent only CA (ablation group) were successfully matched using propensity score matching. After correcting the insufficient ablation, 107 consecutive patients were enrolled prospectively. During the follow-up period, postprocedural 24-hour monitor recordings and a portable electrocardiogram (ECG) monitoring device were used to detect AF recurrence. Transesophageal echocardiography was used to evaluate LAAC. Results: The combined group showed an increase in the risk of AF recurrence after 539.2 ± 304.4 days of follow-up (29.9% vs. 15.9%, p < 0.05). Interestingly, the duration of the procedure was not significantly prolonged when LAAC was added after CA in the combined group, while there was a higher number of ablating attempts, duration of ablation, and additional ablation in the ablation group for both radiofrequency and cryoballoon ablation. After correcting for the insufficient ablation, the corrected group showed a significant decrease in AF recurrence after 420.4 ± 204.8 days of follow-up. Conclusions: Insufficient ablation is common when combining CA and LAAC and may lead to the recurrence of atrial fibrillation. It should be corrected intentionally by sufficient ablation of the pulmonary vein antrum and additional ablation. Clinical Trial Registration: The prospective study is a sub-study of our CAGEDAF study that has already been registered (ChiCTR2000039746).

Keywords
atrial fibrillation
hybrid procedure
left atrial appendage closure
catheter ablation
insufficient ablation
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Funding
20ZR1456700/Natural Science Foundation of Shanghai
2022KY508/Health Commission of Zhejiang Province
82000283/National Natural Science Foundation of China
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