Left atrial appendage occlusion and concomitant catheter ablation procedures

doi:10.1016/j.hrthm.2026.03.1880

Arrhythmias & electrophysiologyResearch article

Left atrial appendage occlusion and concomitant catheter ablation procedures

Heart RhythmPublished 10 Mar 2026

Patients from the Surveillance Postapproval Analysis Plan who underwent concomitant ablation and LAAO were compared with patients who underwent LAAO alone

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Authors' conclusion

Patients undergoing concomitant AF ablation at the time of LAAO are younger and have fewer comorbidities. There was no clinically important difference in LAA seal peridevice leaks with concomitant LAAO; however, there was a higher rate of major bleeding and pericardial effusion requiring intervention.

Study context

Population: Patients undergoing left atrial appendage occlusion (LAAO) in the Surveillance Postapproval Analysis Plan1.9% (n = 1844) underwent concomitant ablation
Participants: 96,968 patients

Comparison: concomitant ablation and LAAO were compared with patients who underwent LAAO alone
Concomitant ablationn = 1,844
Outcome: Complete seal of the left atrial appendage (LAA) (any residual leak)
Follow-up: Immediately after implant and at 45 days

Main finding

As reported in the abstract

Any residual leak immediately after implant

Concomitant ablation1.6%

LAAO alone3.7%

Any residual leak at 45 days

Concomitant ablation15.7%

LAAO alone16.9%

Concomitant ablation vs LAAO alone: P < 0.001 — immediately after implant; lower rates of any residual leak with concomitant ablation
Concomitant ablation vs LAAO alone: P = 0.29 — at 45 days; no difference

Further findings

Composite of all-cause mortality, stroke, or systemic embolism · 1 year after the procedure · less frequent with concomitant ablation

P < 0.0001

Concomitant ablation5.2%

LAAO alone9.3%

Baseline characteristics

Age, median [quartile 1, quartile 3], years Concomitant ablation 73 [68-78] · LAAO alone 76 [72-82]

CHA2DS2-VASc Concomitant ablation 4 [3-5] · LAAO alone 5 [4-6]

Previous clinically relevant bleeding

Concomitant ablation32.4%

LAAO alone56.6%

Fall risk

Concomitant ablation30.2%

LAAO alone42.2%

Discharge drug therapy in the concomitant AF ablation group

direct-acting oral anticoagulant plus aspirin: 56.2%
direct-acting oral anticoagulant alone: 30.0%

Safety

In-hospital major adverse events · more frequent with concomitant ablation

P = 0.0111

Concomitant ablation1.9%

LAAO alone1.2%

In-hospital major bleeding · more frequent with combined LAAO and AF ablation

P = 0.0073

Concomitant ablation1.6%

LAAO alone1.0%

Pericardial effusion requiring intervention · in-hospital · more frequent with combined LAAO and AF ablation

P = 0.0108

Concomitant ablation0.8%

LAAO alone0.4%

Original publication

Left atrial appendage occlusion and concomitant catheter ablation procedures. Heart Rhythm. Published 10 March 2026. doi:10.1016/j.hrthm.2026.03.1880

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Summarised from the published abstract; every number is checked against it