Scott Buzby , 2025-05-02 14:22:00
Key takeaways:
- AF recurrence after catheter ablation was not linked to adverse outcomes, but a nonsignificant trend for worse outcomes was reported.
- Rates of stroke were low, irrespective of AF recurrence.
Atrial fibrillation recurrence after catheter ablation was not significantly linked to major adverse outcomes, regardless of whether patients also underwent left atrial appendage closure or received oral anticoagulation, a speaker reported.
A subanalysis of the OPTION trial was presented at Heart Rhythm 2025.
AF recurrence after catheter ablation was not linked to adverse outcomes, but a nonsignificant trend for worse outcomes was reported. Image: Adobe Stock
“The left atrial appendage is a sophisticated and complex structure that has been shown to have pro-arrhythmogenic properties in patients with persistent AF. Studies have shown that the left atrial appendage can lead to the pathophysiology, progression and maintenance of atrial fibrillation,” Arwa Younis, MD, cardiologist at University of Rochester Medical Center, said during a presentation. “The OPTION trial has demonstrated great safety and efficacy for left atrial appendage closure in patients undergoing AF ablation. However, whether the additional catheter manipulation within the appendage and the implantation of a device would compromise AF ablation outcomes or influence AF recurrence remains unclear. In addition, the impact of AF recurrence in this unique high-risk population on clinical outcomes is also unclear.”
The OPTION trial was the first head-to-head comparison of left atrial appendage (LAA) closure with the Watchman FLX device (Boston Scientific) vs. oral anticoagulation in 1,600 patients with AF and moderate-high risk for stroke who underwent catheter ablation. Patients were randomly assigned to LAA closure or oral anticoagulation 90 to 180 days after catheter ablation for AF (59.4% radiofrequency ablation, 33.2% cryoablation). Pulsed field ablation was not utilized in this trial.
As Healio previously reported, LAA closure was associated similar thromboembolic protection and less bleeding compared with oral anticoagulation among patients who underwent AF ablation.
For the present subanalysis, researchers evaluated the impact of AF recurrence after catheter ablation on incidence of stroke and systemic embolism.
AF recurrence was defined as newly prescribed or increased doses of antiarrhythmic drugs, cardioversion or repeat ablation.
AF recurrence occurred in 52% of the cohort and was not significantly different between the LAA closure and oral anticoagulation groups, according to the presentation.
There was no significant difference in most baseline variables among those who did and did not have AF recurrence.
After multivariate AF adjusted analyses, onset of more than 1 year (OR = 1.836; 95% CI, 1.48-2.28; P < .0001) and persistent AF (OR = 1.738; 95% CI, 1.42-2.13; P < .0001) were both associated with AF recurrence.
The researchers observed a trend toward increased risk for adverse events such as death, stroke or systemic embolism and bleeding events in patients with AF recurrence, but it did not reach statistical significance.
AF recurrence did not significantly impact occurrence of most adverse events when comparing LAA closure vs. oral anticoagulation after AF ablation; however, the researchers observed a significant difference in the composite endpoint of nonprocedural major bleeding or clinically relevant nonmajor bleeding, with a lower incidence in the LAA closure arm (4.7% vs. 8.6%; P = .012).
The rates of stroke or systemic embolism were low, regardless of LAA closure, oral anticoagulation or AF recurrence and ranged from 0.4% to 1.2%, according to the presentation.
“Among high-risk patients undergoing catheter ablation for AF, concomitant or sequential left atrial appendage closure with a Watchman device does not affect AF ablation outcomes,” Younis said during the presentation. “There was a trend toward a higher incidence of adverse events in patients with AF recurrence compared to those without. The overall rates of late stroke or systemic embolism were low with Watchman FLX and oral anticoagulation, irrespective of AF development.”
Sources/Disclosures
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Younis A, et al. Late-breaking clinical trials and science: Clinical trials updates and registries (non-ACE). Presented at: Heart Rhythm 2025; April 24-27, 2025; San Diego.
Disclosures:
The OPTION trial was funded by Boston Scientific. Younis reports receiving research grants from Boston Scientific.
