Open AccessCombined catheter ablation for atrial fibrillation and Watchman® left atrial appendage occlusion procedures: Five‐year experience
Author(s) -
Phillips Karen P.,
Walker Daniel T.,
Humphries Julie A.
Publication year - 2016
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1016/j.joa.2015.11.001
Subject(s) - medicine , atrial fibrillation , occlusion , left atrial appendage occlusion , implant , stroke (engine) , catheter , cardiology , catheter ablation , surgery , pulmonary vein , ablation , concomitant , mechanical engineering , warfarin , engineering
Background Patients with atrial fibrillation (AF) may benefit from undergoing concomitant interventions of left atrial catheter ablation and device occlusion of the left atrial appendage (LAA) as a two‐pronged strategy for rhythm control and stroke prevention. We report on the outcome of combined procedures in a single center case series over a 5‐year timeframe. Methods Ninety‐eight patients with non‐valvular AF and a mean CHA 2 DS 2 ‐VASc score 2.6±1.0 underwent either first time, or redo pulmonary vein isolation (PVI) procedures, followed by successful implant of a Watchman® device. Results All procedures were generally uncomplicated with a mean case time of 213±40 min. Complete LAA occlusion was achieved at initial implant in 92 (94%) patients. Satisfactory LAA occlusion was achieved in 100% of patients at 12 months, with a complete LAA occlusion rate of 86%. All patients discontinued oral anticoagulation. Persistent late peri‐device leaks were more frequently associated with device angulation or shoulder protrusion, and were associated with a significantly lower achieved device compression of 12±3% vs. 15±5% ( p <0.01) than complete occlusion. One ischemic stroke was recorded over a mean follow‐up time of 802±439 days. Twelve months' freedom from detectable AF was achieved in 77% of patients. Conclusions Combined procedures of catheter ablation for AF and Watchman® LAA implant appear to be feasible and safe, with excellent rates of LAA occlusion achieved and an observed stroke rate of 0.5% per year during mid‐term follow‐up. Incomplete occlusion was associated with lower achieved device compression and was more frequently associated with suboptimal device position.