Combined Procedure Versus Catheter Ablation Alone for Atrial Fibrillation: Predictors of Long‐Term Arrhythmia Recurrence

BACKGROUND: Early recurrence (ER) of atrial tachyarrhythmia (ATA) has been proven to predict late recurrence (LR) in patients undergoing catheter ablation (CA). However, the long-term ATA recurrence in patients undergoing combined left atrial appendage closure (LAAC) and CA procedures remains unclear. METHODS: This study aimed to investigate the long-term ATA recurrence after the combined procedure. We enrolled patients with atrial fibrillation (AF) who underwent combined procedures from January 2019 to February 2022. A 1:1 propensity score match was used to identify a comparable cohort from the isolated CA (CA-only) groups. ER and LR were defined as recurrence of ATA during 8 weeks and beyond an 8-week blanking period after ablation. RESULTS: Among the 326 enrolled patients (aged 67.8 ± 8.7 years, 42.9% female, 26.4% paroxysmal AF), the groups were similar regarding the occurrence of ER (LAAC + CA: 25.2% vs. CA-only: 20.9%, p = 0.357). After a 4-year follow-up, the combined group demonstrated a significantly lower ATA-free rate compared to the CA-only group (LAAC + CA: 52.1% vs. CA-only: 63.2%, log-rank, p = 0.049). Based on a multivariate Cox regression analysis, the risk of LR significantly increased in patients with ER (hazard ratio [HR] = 1.789, 95% confidence interval [CI] = 1.194-2.681, p = 0.005), the combined procedure (HR = 1.559, 95% CI = 1.072-2.268, p = 0.020), and increased left atrial diameter (LAD) (HR = 1.036, 95% CI = 1.002-1.071, p = 0.036). CONCLUSIONS: ATA recurrence postprocedure is more frequent in the combined procedure than in the CA-only procedure after the long-term follow-up. ER, the combined procedure, and increased LAD are associated with a higher risk of LR.