Study On The Long-term Effectiveness And Safety Of Radiofrequency Ablation Combined With Left Atrial Appendage Closure In The Treatment Of NVAF

Objective: To evaluate the long-term effectiveness and safety of radiofrequency ablation(RFCA)combined with left atrial appendage closure(LAAC)in both ablation and closure,highlight the advantages of this surgery in terms of time and economic cost,and provide a practical basis for the promotion of this surgery in clinical work.Methods: Continuously select NVAF patients who received interventional therapy in the Department of Cardiology of Yunnan University Affiliated Hospital from January 2019 to December 2021,and divided them into radiofrequency ablation combined with left atrial appendage closure group(one-stop group),77 patients,and radiofrequency ablation alone 96 patients in the RF group(single RF group),62 patients in the single left atrial appendage closure group(single LAAC group).All patients in the one-stop group and single LAAC group chose the WatchmanTM left atrial appendage occluder.One-stop surgery adopts the strategy of ablation first and then closure.A retrospective cohort study was used to collect the baseline data of patients in each group,such as age,sex,body mass index(BMI),type of atrial fibrillation,clinical complications,stroke and bleeding scores,as well as the relevant data during the perioperative period,and the follow-up data after the operation,such as withdrawal of antiarrhythmic drugs,recurrent atrial arrhythmia,repeated ablation,withdrawal of anticoagulant drugs,residual shunt of occluder,device-related thrombosis,ischemic stroke events,bleeding events and death.All the data of patients in the one-stop group were compared with those of the single RF group and the single LAAC group,so as to evaluate the long-term efficacy and safety of the one-stop surgery for NVAF patients.Results:1.Baseline data of patients: The one-stop group had higher CHA2DS2-VASC and HAS-BLED scores compared to the single RF group,and had more cases of stroke/transient ischemic attack(TIA)or thromboembolism in the past.There was no statistically significant difference in all clinical baseline data between the one-stop group and the single LAAC group.2.Perioperative data:(1)The one-stop group had longer surgical time than the single RF group,and there was no statistical difference between the two groups in terms of ablation method,ablation success rate,and perioperative complications.(2)The one-stop group had longer surgical time than the single LAAC group,and there was no statistically significant difference between the two groups in terms of LAA diameter,LAA shape,occluder compression ratio,immediate closure success rate,residual shunt,and perioperative complications.3.Follow-up results:(1)The average follow-up time of the one-stop group was shorter than that of the single RF group,and there was no statistical difference between the two groups in terms of stopping antiarrhythmic drugs,recurrent atrial arrhythmias,repeated ablation,and adverse events during the follow-up period.(2)There was no statistical difference between the one-stop group and the single LAAC group in terms of follow-up time,discontinuation of anticoagulants,residual shunt at3 months after surgery,and incidence of adverse events during the follow-up period.4.Time and cost analysis: The one-stop group has longer surgical time,longer postoperative hospitalization time,and higher hospitalization costs compared to the single RF group and single LAAC group,which saves more time and hospitalization costs compared to sequential RF+LAAC surgery.Conclusions: Under the premise of strictly grasping the surgical indications and following standardized surgical procedures,the one-stop surgical ablation effect is equivalent to that of simple radiofrequency ablation,and the occlusion effect is equivalent to that of simple left atrial appendage occlusion;Compared with single surgery,one-stop surgery does not increase the incidence of perioperative complications and adverse events during follow-up;One stop surgery can reduce the total surgical duration,improve treatment efficiency,reduce total hospitalization time and some repeated examinations,and save hospitalization costs compared to sequential surgery.