Atrial Fibrillation Recurrence After Left Atrial Appendage Occlusion in Patients Undergoing Ablation: OPTION Trial Sub-analysis

Background: It remains unclear whether concomitant or subsequent left atrial appendage closure (LAAC) may affect atrial fibrillation (AF) ablation outcomes. Objectives: This study sought to evaluate the impact of LAAC on AF recurrence and its role in clinical outcomes. Methods: A subanalysis was conducted on 1,600 patients from the randomized OPTION (Comparison of Anticoagulation With Left Atrial Appendage Closure After AF Ablation) trial. Patients were stratified into 2 groups: anticoagulation (no device) and LAAC. The primary endpoint was AF recurrence, and the secondary endpoint was stroke or systemic embolism occurring after 12 months of follow-up. Patients were categorized based on AF recurrence (yes/no) at 12 months. Arrhythmia recurrence was assessed using device interrogations in patients with cardiac implantable electronic devices and 12-lead electrocardiograms in those without devices. Results: Of the total cohort, 803 patients (50%) underwent LAAC (41% concomitant, 59% sequential), and 797 patients (50%) were in the control group (no device). Baseline characteristics were balanced across both treatment arms. At 36-month follow-up, AF recurrence rates did not differ significantly between the groups (LAAC: 49.2% vs no LAAC: 45.5%; P = 0.08). No difference was found between sequential and concomitant LAAC (43.6% vs 43.9%, respectively; P = 0.83). Stroke and systemic embolism rates were low and comparable between patients with and without AF recurrence (no AF: 1.00%, AF recurrence: 1.30%; P = 0.57). Conclusions: Among patients undergoing AF ablation, LAAC (concomitant or sequential) does not affect AF ablation outcomes. The stroke/systemic embolism rate was low in all groups. Nevertheless, the trial highlights that stroke and systemic embolism remain significant risks, even in patients without AF recurrence, and should not be overlooked.