OBJECTIVES: Catheter ablation (CA) of atrial fibrillation (AF) relieves symptoms and reduces arrhythmia burden, but oral anticoagulation remains necessary in patients with elevated risk of stroke, leaving them at risk of bleeding. Left atrial appendage closure (LAAC) is an alternative for stroke prevention for non-valvular AF patients and has been reported to be performed concomitantly or following CA. While waiting for LAAC, patients remain at risk for thromboembolic and bleeding events. This study examined days from CA to LAAC and adverse events (AE) during that time.

METHODS: A retrospective analysis of the 100% Medicare Standard Analytical Files from 2016-2022. Inclusion criteria were one CA occurring up to 180 days before an LAAC, age 65 or older, and continuous enrollment 12 months prior and 6 months post the CA. AEs (ischemic stroke, intracranial bleeds, major gastrointestinal (GI) bleeds, and other major bleeds) between procedures were counted, along with unique beneficiaries and provider encounters associated with AEs. Cumulative median CMS payments were compared for beneficiaries with and without an AE and Wilcoxon-Mann-Whitney tested for differences.

RESULTS: Of the 4,325 beneficiaries that met inclusion criteria, the mean time between procedures was 91 days, and 607 beneficiaries (14.0%) had at least one AE, for 1,881 unique AEs, and 1,053 encounters. 1,021 of the 1,881 AEs (54.3%) were major GI bleeds, 562 (29.9%) other major bleeds, 121 (6.4%) intracranial bleeds, and 177 (9.4%) ischemic strokes. 261 (6.0%) experienced inpatient hospitalization(s) and 98 (2.3%) experienced ED visit(s) associated with an AE. Median cumulative CMS payments were significantly larger for beneficiaries with AEs ($6,513 vs $257, p<0.001).

CONCLUSIONS: The average wait from receiving CA to LAAC is 3 months, during which beneficiaries are at risk of associated AEs. Given the high rate of AEs identified, it is important to consider the benefit of combined CA and LAAC procedures for appropriate patients.