Efficacy and Safety of Combined Catheter Ablation and Left Atrial Appendage Closure in Atrial Fibrillation: A Systematic Review and Meta-Analysis

The combination of catheter ablation (CA) and left atrial appendage closure (LAAC) has emerged as a potential therapeutic strategy for patients with atrial fibrillation (AF). This systematic review and meta-analysis evaluated the efficacy and safety of the combined approach compared with CA alone. We conducted a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library from inception to January 10, 2025. Studies comparing CA plus LAAC with CA alone were included. Of 1,066 identified articles, 11 studies met the inclusion criteria. The mean follow-up duration ranged up to 24 months, with reported CHA₂DS₂-VASc scores ranging from 2.2 to 4.3 and HAS-BLED scores from 2.0 to 3.7. Meta-analysis showed no significant difference in thromboembolic events between the combined and control groups (RR: 1.42, 95% CI: 1.10-1.83, I² = 0%), and no significant difference in arrhythmia recurrence (RR: 1.02, 95% CI: 0.84-1.24, I² = 28%). However, the combined approach was associated with a significantly higher risk of procedural complications (RR: 1.61, 95% CI: 1.01-2.59, I² = 0%). These findings suggest that adding LAAC to CA does not reduce thromboembolic events or arrhythmia recurrence but may increase the risk of procedural complications. Given the predominance of observational studies and limited randomized controlled trial (RCT) data, larger high-quality trials are needed to more definitively assess the role of combined CA and LAAC in AF management.