In Frontiers in Cardiovascular Medicine, researchers presented a meta-analysis that compared outcomes of catheter left atrial appendage occlusion combined with ablation (COA) and thoracoscopic surgical left atrial appendage clipping combined with ablation (TCA) in patients with atrial fibrillation. Reportedly, stroke prevention and all-cause mortality did not significantly differ between COA and TCA, and postprocedural complications and mortality were “almost comparable.”
This meta-analysis included 19 studies on COA and 6 studies on TCA with 1504 and 454 patients, respectively, published to the PubMed, Embase, Cochrane, and Web of Science databases. The primary end point of interest was stroke incidence over a follow-up of at least 12 months for either method.
COA and TCA Ablation for AF Yield Similar Outcomes
According to the authors, COA and TCA showed no significant differences for stroke (P=.504) or all-cause mortality (P=.611) after follow-up. Additionally, COA achieved a higher success rate of complete left atrial appendage closure compared with TCA (P=.001); however, the authors noted that COA exhibited a higher risk of bleeding in the postprocedural period (P=.023) as well as other postprocedural complications and mortality (P>.05).
The study was limited by a lack of available randomized controlled trials and an overall small sample size. The authors acknowledged that differences between the enrolled studies also created potential confounders in different antithrombotic therapies, persistent versus paroxysmal atrial fibrillation, and other variables.
Despite the study’s limitations, the authors supported that COA and TCA both yield comparable outcomes in patients undergoing catheter ablation for atrial fibrillation and suggested that “large randomized clinical trials investigating the optimal strategy for [atrial fibrillation] and efficacy and safety outcomes of different procedures are warranted in the near future.”