Introduction
Oral anticoagulation (OAC) is the cornerstone of stroke prevention in non-valvular atrial fibrillation (NVAF) when CHADS-VASC score are high (1,2). However, contraindication for long-term OAC related to comorbidities, personal history of bleeding or persistent risk of bleeding remains a frequent issue in clinical practice (3). In NVAF, thrombi typically occur in the left atrial appendage (4), and over the last years, left atrial appendage closure (LAAC) with an occluder device has emerged as an alternative to OAC in selected patients (5,6).
Different design and generations of devices are available for percutaneous LAA closure: Watchman devices™, ACP™ and Amulet™ devices, WaveCrest™, and LAmbre™ (7).
Recently, combined strategy of concomitant LAAC for stroke prevention and catheter ablation (CA) for AF was proposed, and an international multicenter registry support the feasibility and safety of this strategy (8,9). The combined strategy of concomitant CA and LAAC procedures in symptomatic AF patients with high risk of stroke and bleeding may be a cost-effective therapeutic option compared with CA and long term standard oral anticoagulation (OAC) (10). Moreover, in patients with both NVAF and patent foramen oval (PFO) or atrial septal defect (ASD), LAAC combined with PFO or ASD closure was previously reported (11,12). Finally, other percutaneous procedures such as leadless intracardiac transcatheter pacing systems implantation or transcatheter edge-to-edge mitral valve repair (TEMVR) may be combined with LAAC (13-16). Recent publication have shown the possibility to associate safely LAAC using AmplatzerTM devices with structural, coronary, or electrophysiological concomitant procedures (16). Combined approach could thus allow to treat several cardiac conditions in a single intervention.
Here, we report our single center experience of a combined strategy with LAAC procedure using the WatchmanTM (WN) devices and other percutaneous procedures.