Safety and Outcomes of Concomitant Left Atrial Appendage Occlusion and Atrial Fibrillation Ablation

BACKGROUND: Performing atrial fibrillation (AF) catheter ablation and percutaneous left atrial appendage occlusion (LAAO) during a single procedure may improve efficiency and reduce cumulative procedural risk. However, concerns remain regarding potential increases in periprocedural and longer-term complications, including stroke, pericardial effusion, device leak, and device-related thrombus. Evidence evaluating the safety of this concomitant strategy remains limited. OBJECTIVES: The objectives of the study was to compare the safety and short- and long-term outcomes of concomitant AF ablation plus LAAO vs LAAO alone. METHODS: We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network, identifying adults (≥18 years) with AF who underwent percutaneous LAAO between January 2015 and February 2026. Patients undergoing AF ablation on the same day as LAAO were compared with those undergoing LAAO alone. After 1:1 propensity score matching for demographics, comorbidities, cardiovascular medications, and laboratory values, 1,899 patients were included in each group. Outcomes including all-cause mortality, stroke, device leak, device-related thrombus, pericardial effusion, and pericardiocentesis were assessed at 7 days, 90 days, and 1 year using cumulative incidence and Cox proportional hazards models. RESULTS: Baseline characteristics were well balanced after matching. Concomitant AF ablation was not associated with increased adverse events. Mortality was similar at 90 days (0.6% vs 0.6%; HR: 1.00; 95% CI: 0.43-2.32) and 1 year (1.4% vs 1.5%; HR: 0.97; 95% CI: 0.58-1.63). At 90 days, rates of stroke, device leak, and device-related thrombus were comparable between groups, with no differences observed at 1 year. CONCLUSIONS: In this large, propensity-matched analysis, concomitant AF ablation at the time of LAAO was not associated with increased early or 1-year complications, supporting the safety of a combined approach in appropriately selected patients.