Arrhythmias & electrophysiology
Comparison of left atrial appendage closure and oral anti-coagulation after catheter ablation for atrial fibrillation: Concomitant and sequential cohorts of the OPTION randomized controlled trial
Authors' conclusion
For both Concomitant and Sequential ablation timing strategies, LAAC has similar efficacy compared with OAC and a lower risk of clinically important post-procedure bleeding in high-risk patients following AF ablation.
Study context
- Population
- Patients with atrial fibrillation (AF) and an elevated CHA2DS2-VASc score undergoing catheter ablation; Sequential (ablation 90–180 days prior to randomization) or Concomitant (within 10 days of randomization) timingConcomitant n = 654
- Comparison
- Device vs Control
- Primary endpoint
- Safety: non-procedural major or clinically-relevant non-major bleeding; efficacy: all-cause death, stroke or systemic embolism
- Follow-up
- 36 months
Methodological detailsmulticentre, prospective, stratified by ablation timing, subgroup analysis
- Multicentre
- Prospective
- Stratified by ablation timing
- Subgroup analysis
Primary result
As reported in the abstract
Primary safety and efficacy end points, by ablation timing
- Concomitant (n = 654) and Sequential (n = 946): Device vs Control had fewer primary safety end point events
- Concomitant and Sequential: similar rates of primary efficacy events with Device vs Control
Safety
- Similar rates of secondary safety events with Device vs Control in both timing cohorts
- Acute safety events low and similar between Device and Control in the Concomitant cohort; adding left atrial appendage closure (LAAC) to ablation sessions did not increase procedural events
Original publication
Comparison of left atrial appendage closure and oral anti-coagulation after catheter ablation for atrial fibrillation: Concomitant and sequential cohorts of the OPTION randomized controlled trial. Heart Rhythm. Published 25 April 2025. doi:10.
Summarised from the published abstract; every number is checked against it