Prior Stroke Increases Residual Shunt Risk After Combined Ablation and LAAO: A Device‐Specific Interaction

ABSTRACT Background The safety and efficacy profile of the combined “one‐stop” catheter ablation (CA) and left atrial appendage occlusion (LAAO) procedure in atrial fibrillation (AF) patients with a prior history of cerebral infarction requires further validation. Methods In this retrospective, single‐center study, 242 consecutive AF patients undergoing the one‐stop procedure were categorized into Stroke ( n = 103) and Non‐Stroke ( n = 139) groups. A 1:1 propensity score matching (PSM) was performed, yielding 57 balanced pairs. The primary efficacy endpoint was procedural success. Key safety endpoints included post‐procedural residual shunt assessed at 45 days, device‐related thrombosis (DRT), and stroke recurrence. Results After PSM, baseline characteristics were well‐balanced. Procedural success (91.2% vs. 87.7%, p = 0.484) and freedom from AF recurrence (88.6% vs. 89.3%, p = 0.979) were comparable between Stroke and Non‐Stroke groups. However, the incidence of residual shunt was significantly higher in the Stroke group (5.3% vs. 0%, p = 0.028). No significant differences were observed in DRT or stroke recurrence rates. Notably, a significant interaction was found between prior stroke and LAAO device type on residual shunt risk ( p ‐for‐interaction = 0.045), indicating the risk varied substantially depending on the occluder used. Conclusion A history of prior stroke does not impair the procedural success or mid‐term rhythm control of the one‐stop CA+LAAO strategy. However, it is associated with an increased risk of residual shunt, a relationship significantly modified by the type of occluder device. These findings highlight the potential need for individualized device selection in stroke survivors.