Ablation for atrial fibrillation in combination with left atrial appendage closure: first results of a feasibility study.

Drug-refractory atrial fibrillation (af) increasingly is being treated with catheter ablation. however,the long-term success rate,expressed as freedom from af,is <50%. therefore,vitamin k antagonists,with all their complications,remain necessary. recently,left atrial appendage (laa) occlusion devices were introduced as an alternative to vitamin k antagonists. here,we investigated whether af ablation and laa occlusion could be a feasible and safe combination in patients with symptomatic drug-refractory af and a chads(2) score ≥1 or a contraindication for vitamin k antagonists. ablation was performed by using multielectrode catheters with phased radiofrequency energy. laa was occluded with the watchman device (atritech,inc,plymouth,mn). between february 2010 and february 2011,30 patients were treated (21 male; age,62.8±8.5 years). median chads(2) score was 2.5 (25th to 75th percentiles: 2 to 3),median chads-vasc score was 3 (25th to 75th percentiles: 3 to 5),77% had prior stroke,and 27% had a contraindication for vitamin k antagonists. median has-bled score was 2 (range,1 to 5). successful device implantation was achieved with a median number of 1.5 devices (median diameter 24 mm [25th to 75th percentiles: 24 to 24 mm]). total procedure time was 97 minutes (25th to 75th percentiles: 75 to 115 minutes). at 60 days,all patients met the criteria for successful sealing. follow-up visit at 12 months showed a 30% rate of documented recurrence of af. a repeated pulmonary vein isolation was performed successfully in 4 patients,without interference of the laa closure device. no thromboembolic events occurred during 1-year follow-up. laa occlusion with the watchman device and af ablation can be combined successfully and safely in a single procedure. the watchman does not interfere with a repeated ablation.