Safety and Efficacy of Left Atrial Ablation After Percutaneous Left Atrial Appendage Occlusion in High-Bleeding-Risk Patients with Atrial Fibrillation: A Multicenter Analysis from the PROCEED-AF Ablation Registry

BACKGROUND AND AIMS: Patients with left atrial appendage (LAAO) devices are increasingly referred for AF ablation, yet anticoagulation strategies remain uncertain. The goal of this study was to evaluate the safety and efficacy of catheter ablation for atrial fibrillation (AF) in patients with pre-existing LAAO devices and to describe patterns in anticoagulation management after ablation in this unique population. METHODS: We collected data from 14 centers worldwide on patients with prior LAAO devices undergoing AF ablation. Each site provided clinical characteristics, procedural details, and information on complications and arrhythmia outcomes. Data were aggregated and analyzed centrally to evaluate procedural safety, efficacy, and variability in management strategies. RESULTS: A total of 198 patients (age 70 years, 37% female, 42% paroxysmal AF) with prior LAAO were included. Ablation was performed a median of 271 days after LAAO. After ablation, 84% of patients were on oral anticoagulation (OAC), most commonly for 2-3 months. Bleeding complications on OAC occurred in 6.7% of patients at a median of 20 (13, 70) days after ablation. Stroke or TIA occurred in 5 patients (2.6% of cases) within the follow-up period with 2 occurrences (1% of cases) the day after ablation. There were 2 cases of new or worsened peri-device leak after ablation. CONCLUSION: In a large, international registry of patients undergoing catheter ablation for AF with pre-existing LAAO devices, ablation was feasible and device related complications were rare Despite higher bleeding risk in an LAAO population, 84% of patients with prior LAAO tolerated short term OAC post-ablation with bleeding events at expected rates for this population.

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Journal
EP Europace
Published
2026-09-25
DOI
https://doi.org/10.1093/europace/euag277
Primary Topic
Atrial Fibrillation Management and Outcomes
Type
article
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article

Safety and Efficacy of Left Atrial Ablation After Percutaneous Left Atrial Appendage Occlusion in High-Bleeding-Risk Patients with Atrial Fibrillation: A Multicenter Analysis from the PROCEED-AF Ablation Registry

Mason Yoder, Laurent Roten, Thomas Kueffer, Jorge E. Romero et al.
EP Europace
Atrial Fibrillation Management and Outcomes
article

Safety and Efficacy of Left Atrial Ablation After Percutaneous Left Atrial Appendage Occlusion in High-Bleeding-Risk Patients with Atrial Fibrillation: A Multicenter Analysis from the PROCEED-AF Ablation Registry

Mason Yoder, Laurent Roten, Thomas Kueffer, Jorge E. Romero, Fengxiang Zhang, Bradley P. Knight, Rachel M. Kaplan, Paolo Compagnucci, David Schaack, William H. Sauer, K. R. Julian Chun, Boris Schmidt, Serge Bovéda, Tom J. R. De Potter, Michael Kühne, Christian‐Hendrik Heeger, Jeanne du Fay de Lavallaz, Mark T Mills, Raktham Mekritthikrai, Patrick Badertscher, Dhiraj Gupta, Christian Sticherling, Jonathan W. Waks, Antonio Dello Russo, Pipin Kojodjojo, Tobias Reichlin, Robin Richard-Vitton, Graham Peigh, Timothy M. Markman, Jeffrey Winterfield, Ghanshyam Shantha, Kenneth Brownell, Henry D Huang, Fernando Moreno, Konstantia Paraskevi Gkini, Smit C Vasaiwala, Nishant Verma, Hakan Oral
article en

Abstract

BACKGROUND AND AIMS: Patients with left atrial appendage (LAAO) devices are increasingly referred for AF ablation, yet anticoagulation strategies remain uncertain. The goal of this study was to evaluate the safety and efficacy of catheter ablation for atrial fibrillation (AF) in patients with pre-existing LAAO devices and to describe patterns in anticoagulation management after ablation in this unique population. METHODS: We collected data from 14 centers worldwide on patients with prior LAAO devices undergoing AF ablation. Each site provided clinical characteristics, procedural details, and information on complications and arrhythmia outcomes. Data were aggregated and analyzed centrally to evaluate procedural safety, efficacy, and variability in management strategies. RESULTS: A total of 198 patients (age 70 years, 37% female, 42% paroxysmal AF) with prior LAAO were included. Ablation was performed a median of 271 days after LAAO. After ablation, 84% of patients were on oral anticoagulation (OAC), most commonly for 2-3 months. Bleeding complications on OAC occurred in 6.7% of patients at a median of 20 (13, 70) days after ablation. Stroke or TIA occurred in 5 patients (2.6% of cases) within the follow-up period with 2 occurrences (1% of cases) the day after ablation. There were 2 cases of new or worsened peri-device leak after ablation. CONCLUSION: In a large, international registry of patients undergoing catheter ablation for AF with pre-existing LAAO devices, ablation was feasible and device related complications were rare Despite higher bleeding risk in an LAAO population, 84% of patients with prior LAAO tolerated short term OAC post-ablation with bleeding events at expected rates for this population.

EP Europace
Northwestern University (US), University of Bern (CH), Brigham and Women's Hospital (US), Rush University Medical Center (US), Loyola University Medical Center (US), Beth Israel Deaconess Medical Center (US), University of Liverpool (GB), Medical University of South Carolina (US), SUNY Upstate Medical University (US), University of Michigan (US), University Hospital of Bern (CH), California University of Pennsylvania (US), Wuhan University (CN), University of Chicago (US), Cardiovascular Center Bethanien (DE), Hospital Base (CL), Northwestern University (PH), Onze Lieve Vrouwziekenhuis Hospital (BE), Wuhan Asia Heart Hospital (CN), Cardiovascular Center Frankfurt (DE), Clinique Pasteur (FR), National Heart Centre Singapore (SG), Ospedali Riuniti Umberto I (IT), Wake Forest University (US), University of Pennsylvania (US), Nanjing Medical University (CN), University of Lübeck (DE)
Openalex Percentile: Top 11%
Atrial Fibrillation Management and Outcomes
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