The aim of this study was to evaluate the safety and efficacy of concomitant cryoballoon ablation and left atrial appendage closure (LAAC) in non-valvular atrial fibrillation (NVAF) patients.

The retrospective study enrolled the consecutive NVAF patients with high risk of stroke who underwent concomitant cryoballoon ablation and LAAC in the First Affiliated Hospital of Wenzhou Medical University from June 2015 to July 2017. Complete closure was attempted for each patient without any peri-device flow. Electrocardiogram (ECG) , dynamic electrocardiogram (DCG) , and esophageal echocardiography (TEE) were performed at regular follow-up to evaluate the safety and efficacy.

A total of 74 patients underwent the cryoballoon ablation combined with LAAC. The male was 42 (56.8%) and female was 32 (43.2%) . The mean age was (70.2±8.1) years. Paroxysmal AF was present in 62 (83.8%) patients and persistent AF (< 3 months) was present in 12 (16.2%) . Mean CHA₂DS₂VASc score was 4.0±1.5. Mean HAS-BLED score was 3.3±1.0. Of all patients, pulmonary vein isolation and complete LAAC were achieved successfully. Watchman devices were implanted in 55 patients, while recapture procedure were performed in 31 (56.4%) patients for an optimum position. Amplatzer Cardiac Plug (ACP) devices were implanted in 19 patients while recapture procedure were performed in 8 (42.1%) patients for an optimum position. Among 19 patients with ACP implanted, 5 patients achieved procedure using ACP device with a prior failed Watchman device implantation due to unsatisfactory pre-device leak. Five patients of Watchman and 1 case of ACP were replaced with the same occluder of different specifications successfully. Complete closure was achieved in 72 (97.3%) patients without any peri-device residual leakage. The mean follow-up time was (23.3±7.0) months. AF recurrence was documented in 26 (35.1%) patients. At 45-day, 6-month and 1-year TEE follow-up examinations, the follow-up rate was 98.6% (73/74) , 67.6% (50/74) and 66.2% (49/74) , the complete closure rate was 82.2%, 88.0%, 91.8%, respectively. No case had >3 mm residual leakage. Seventy-three (98.6%) patients discontinued anticoagulants treatment at 3 months follow-up. One patient occurred non-cardiogenic death. One patient occurred ischemic stroke. Two patients occurred major bleeding events. One patient occurred device related thrombus.

The concomitant cryoballoon ablation and complete LAAC are safe and efficacious way for symptomatic NVAF patients with high stroke risk.

Atrial fibrillation; Cryoballoon ablation; Left atrial appendage closure; Stroke