• 1 HeartCare Partners, Greenslopes Private Hospital, Brisbane, Australia
  • 2 State Research Institute of Circulation Pathology, Novosibirsk, Russia
  • 3 Medical Centre Leeuwarden, Leeuwarden, the Netherlands
  • 4 Erasmus MC, Rotterdam, the Netherlands
  • 5 Ospedale Civile, Cirie, Italy
  • 6 Boston Scientific Corp, St. Paul, USA
  • 7 National Heart Institute, Kuala Lumpur, Malaysia
  • 8 St. Antonius Hospital, Nieuwegein, The Netherlands
Europace, 2018 06 01;20(6):949-955.
PMID: 29106523 DOI: 10.1093/europace/eux183


Aims: Long-term results from catheter ablation therapy for atrial fibrillation (AF) remain uncertain and clinical practice guidelines recommend continuation of long-term oral anticoagulation in patients with a high stroke risk. Left atrial appendage closure (LAAC) with Watchman has emerged as an alternative to long-term anticoagulation for patients accepting of the procedural risks. We report on the initial results of combining catheter ablation procedures for AF and LAAC in a multicentre registry.

Methods and results: Data were pooled from two prospective, real-world Watchman LAAC registries running in parallel in Europe/Middle-East/Russia (EWOLUTION) and Asia/Australia (WASP) between 2013 and 2015. Of the 1140 patients, 139 subjects at 10 centres underwent a concomitant AF ablation and LAAC procedure. The mean CHA2DS2-VASc score was 3.4 ± 1.4 and HAS-BLED score 1.5 ± 0.9. Successful Watchman implantation was achieved in 100% of patients. The overall 30-day serious adverse event (SAE) rate was 8.7%, with the device and/or procedure-related SAE rate of 1.4%. One pericardial effusion required percutaneous drainage, but there were no strokes, device embolization, or deaths at 30 days. The 30-day bleeding SAE rate was 2.9% with 55% of patients prescribed NOAC and 38% taking warfarin post-procedure.

Conclusion: The outcomes from these international, multicentre registries support the feasibility and safety of performing combined procedures of ablation and Watchman LAAC for patients with non-valvular AF and high stroke risk. Further data are needed on long-term outcomes for the hybrid technique on all-cause stroke and mortality.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.