Key takeaways:
- AF recurrence after catheter ablation was not linked to adversarial outcomes, however a nonsignificant pattern for worse outcomes was reported.
- Charges of stroke have been low, regardless of AF recurrence.
Atrial fibrillation recurrence after catheter ablation was not considerably linked to main adversarial outcomes, no matter whether or not sufferers additionally underwent left atrial appendage closure or acquired oral anticoagulation, a speaker reported.
A subanalysis of the OPTION trial was offered at Coronary heart Rhythm 2025.
“The left atrial appendage is a classy and sophisticated construction that has been proven to have pro-arrhythmogenic properties in sufferers with persistent AF. Research have proven that the left atrial appendage can result in the pathophysiology, development and upkeep of atrial fibrillation,” Arwa Younis, MD, heart specialist at College of Rochester Medical Middle, mentioned throughout a presentation. “The OPTION trial has demonstrated nice security and efficacy for left atrial appendage closure in sufferers present process AF ablation. Nevertheless, whether or not the extra catheter manipulation throughout the appendage and the implantation of a tool would compromise AF ablation outcomes or affect AF recurrence stays unclear. As well as, the affect of AF recurrence on this distinctive high-risk inhabitants on scientific outcomes can also be unclear.”
The OPTION trial was the primary head-to-head comparability of left atrial appendage (LAA) closure with the Watchman FLX machine (Boston Scientific) vs. oral anticoagulation in 1,600 sufferers with AF and moderate-high danger for stroke who underwent catheter ablation. Sufferers have been randomly assigned to LAA closure or oral anticoagulation 90 to 180 days after catheter ablation for AF (59.4% radiofrequency ablation, 33.2% cryoablation). Pulsed subject ablation was not utilized on this trial.
As Healio beforehand reported, LAA closure was related related thromboembolic safety and fewer bleeding in contrast with oral anticoagulation amongst sufferers who underwent AF ablation.
For the current subanalysis, researchers evaluated the affect of AF recurrence after catheter ablation on incidence of stroke and systemic embolism.
AF recurrence was outlined as newly prescribed or elevated doses of antiarrhythmic medication, cardioversion or repeat ablation.
AF recurrence occurred in 52% of the cohort and was not considerably totally different between the LAA closure and oral anticoagulation teams, based on the presentation.
There was no vital distinction in most baseline variables amongst those that did and didn’t have AF recurrence.
After multivariate AF adjusted analyses, onset of greater than 1 yr (OR = 1.836; 95% CI, 1.48-2.28; P < .0001) and chronic AF (OR = 1.738; 95% CI, 1.42-2.13; P < .0001) have been each related to AF recurrence.
The researchers noticed a pattern towards elevated danger for adversarial occasions resembling demise, stroke or systemic embolism and bleeding occasions in sufferers with AF recurrence, but it surely didn’t attain statistical significance.
AF recurrence didn’t considerably affect prevalence of most adversarial occasions when evaluating LAA closure vs. oral anticoagulation after AF ablation; nonetheless, the researchers noticed a big distinction within the composite endpoint of nonprocedural main bleeding or clinically related nonmajor bleeding, with a decrease incidence within the LAA closure arm (4.7% vs. 8.6%; P = .012).
The charges of stroke or systemic embolism have been low, no matter LAA closure, oral anticoagulation or AF recurrence and ranged from 0.4% to 1.2%, based on the presentation.
“Amongst high-risk sufferers present process catheter ablation for AF, concomitant or sequential left atrial appendage closure with a Watchman machine doesn’t have an effect on AF ablation outcomes,” Younis mentioned through the presentation. “There was a pattern towards a better incidence of adversarial occasions in sufferers with AF recurrence in comparison with these with out. The general charges of late stroke or systemic embolism have been low with Watchman FLX and oral anticoagulation, regardless of AF improvement.”
Sources/Disclosures
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Younis A, et al. Late-breaking scientific trials and science: Medical trials updates and registries (non-ACE). Introduced at: Coronary heart Rhythm 2025; April 24-27, 2025; San Diego.
Disclosures:
The OPTION trial was funded by Boston Scientific. Younis studies receiving analysis grants from Boston Scientific.
