Effect of catheter ablation combined with left appendage occlusion for non-valvular atrial fibrillation: a meta-analysis

Objective: To estimate the effect of catheter ablation combined with left appendage occlusion in the treatment of non-valvular atrial fibrillation (NVAF) by a method of meta-analysis.

Methods: Pubmed, Embase, and Cochrane Library were searched for the studies about catheter ablation combined with left appendage occlusion in treating NVAF. The data analysis was performed using R 4.0.5 software. The retrieval time was from inception to May 12, 2021.

Results: A total of 18 published studies were identified in the meta-analysis, including 1385 participants. During the perioperative period of catheter ablation combined with left appendage occlusion in treating NVAF, the pooled incidences of pericardial effusion, major or minor bleeding events, and residual flow documented were 0.5%(95%CI 0.0002-0.0099), 1.42%(95% CI 0.00-0.04), 7.24%(95% CI 0.0447-0.0975), respectively. During the follow-up, the incidences of all-cause mortality, embolism events, and bleeding events were 0.32%(95%CI 0.0000-0.0071), 1.29%(95%CI 0.0037-0.0222), 2.07%(95% CI 0.0075-0.0339), respectively. In the follow-up period of the transesophageal echocardiography, the most complication was residual flow event with an incident rate of 10.80%(95% CI 0.054-0.1620). The maximum occurrence probability of residual flow events was 17.92% (95% CI 0.1133-0.2452). Moreover, the incident rate of NVAF recurrence was 29.23% (95% CI 0.2222-0.3623).

Conclusion: The meta-analysis suggests that the "one-stop" procedure is effective for those patients undergoing NVAF. However, Patients with more residual blood flow have a higher incidence of bleeding complications. More studies are warranted to verify the safety and efficacy of catheter ablation combined with left appendage occlusion in terms of the "one-stop" procedure.