Clinical Outcomes of Different Stroke Prevention Strategies in Patients With Inadvertent Left Atrial Appendage Electrical Isolation

BACKGROUND: Inadvertent left atrial appendage electrical isolation (LAAEI) during persistent atrial fibrillation (AF) ablation increases thromboembolic risk. The optimal antithrombotic strategy for these patients remains unclear. OBJECTIVES: This study aimed to compare the safety and efficacy of left atrial appendage closure (LAAC) performed within 3 months after catheter ablation versus long-term postoperative received direct oral anticoagulants (DOACs) in patients with persistent AF who experienced inadvertent LAAEI during catheter ablation. METHODS: The single-center retrospective analysis included 225 patients with inadvertent LAAEI during persistent AF ablation between January 2019 and March 2024. After propensity score matching (PSM), 144 patients were analyzed: 72 received LAAC (LAAC group), and 72 received DOACs (DOAC group). Outcomes, including bleeding and thromboembolic events, were assessed over a mean follow-up of 827 days. RESULTS: The LAAC group had significantly fewer non-procedure-related major and clinically relevant nonmajor bleeding events compared to the DOAC group (HR = 0.417, 95% CI: 0.181-0.960, p = 0.034). Thromboembolic events were similar (HR = 0.246, 95% CI: 0.071-0.851, p = 0.205). Atrial arrhythmia recurrence rates were comparable (HR = 0.939, 95% CI: 0.587-1.502, p = 0.054). Normal LAA function was observed in 41.67% of the DOAC group, while the LAAC group had two cases of device-related thrombus resolved with anticoagulation. CONCLUSIONS: LAAC within 3 months after catheter ablation may reduce bleeding risk while maintaining efficacy comparable to long-term DOACs in patients with inadvertent LAAEI. LAAC represents a safe and effective strategy for this population.