Hospital outcomes of patients receiving catheter ablation of atrial fibrillation, left atrial appendage closure, or both

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Background: Catheter ablation (CA) and left atrial appendage closure (LAAC) require transseptal access; combining both in a single procedure may have advantages. However, the safety of this approach has not been extensively studied. The objective of this study was to compare in hospital outcomes among patients receiving CA, LAAC, and combination of both treatments on the same day. Methods: We conducted a retrospective cohort analysis of the National Inpatient Sample database. The primary outcome was the presence of major adverse cardiovascular and cerebrovascular events (MACCE) during index hospitalization. Secondary outcomes included stroke, pericardial effusion, pericardiocentesis, and bleeding. Results: A total of 69,285 hospitalizations with AF were included in the analysis, of which 71.7% received LAAC, 27.8% received CA, and 0.5% received combination of both treatments on the same day. MACEE (OR, 1.63; 95% CI, 0.39–6.70), stroke (OR, 2.98; 95% CI, 0.55–16.01), pericardial effusion (OR, 0.33; 95% CI, 0.07–1.41), pericardiocentesis (OR, 1.00; 95% CI, 0.25–3.86), and bleeding (OR, 3.25; 95% CI, 0.87–12.07) did not differ significantly between CA and combination treatment. Similarly, MACCE (OR, 1.11; 95% CI, 0.28–4.41), stroke (OR, 1.03; 95% CI, 0.24–4.35), pericardial effusion (OR, 0.45; 95% CI, 0.11–1.90), pericardiocentesis (OR, 0.63; 95% CI, 0.14–2.83), and bleeding (OR, 2.04; 95% CI, 0.65–6.39) did not differ significantly between LAAC and combination treatment. Conclusions: The combined approach is infrequently used in clinical practice (< 1%). However, major life-threatening adverse events did not differ between CA and LAAC when performed in isolation or combined in a single procedural stage on the same day.