Christian-Hendrik Heeger, Laurent Roten, Domenico Della Rocca, Vedran Velagić, Dhiraj Gupta, Tom De Potter, Christian Sticherling, Lukas Urbanek, Boris Schmidt, Abdul Shokor Parwani, Ignacio Garcia-Bolao, Rocco Arancio, Amr Nawar, Shibu Mathew, Jennifer Beney, Henning Rolfes, Kolya Sievert, Serge Boveda, Antoine Lepillier, Marjorie Niro, Reza Wakili, Alexander Steger, Ahmad Awada, Vedran Pasara, Grégoire Massoullié, Andrija Nekic, Maarten Vanhaverbeke, Alexandre Almorad, Romain Eschalier, Maxim Didenko, Marco Contarini, Lorenz Räber, Jan-Per Wenzel, Manuel Rattka, Daniel Scherr, Roland Richard Tilz, Martin W Bergmann
In this large multicentre study, concomitant PFA-based AF ablation and LAA closure proved to be feasible, effective, and safe and overall procedure duration was short.
AIMS: Atrial fibrillation (AF) ablation by pulmonary vein isolation (PVI) and left atrial appendage closure (LAAC) are increasingly performed as standalone procedures. Given that PVI and LAAC share the same access route, a combined approach of pulsed field ablation (PFA)-based PVI and LAAC might be beneficial. The COCONUT study focused on safety, efficacy, and outcomes combining PVI by PFA with LAAC in one procedure.
METHODS: This is a retrospective, multinational registry study. The primary endpoints were the following: (1) primary safety endpoint: serious adverse events; and (2) primary efficacy endpoint: success of PVI and LAA closure defined as the ability to isolate all pulmonary veins and the successful closure of the LAA. For secondary endpoints, peri-procedural data and follow-up data were collected.
RESULTS: A total of 155 patients from 22 centres of nine European countries were treated by concomitant pentaspline catheter PFA-based PVI and LAAC. The mean CHA2DS2-VA score was 3.1 ± 1.4. The primary efficacy endpoint was achieved at 97.4% with successful PVI at 100% and successful LAAC in 151/155 patients (97.4%). The primary safety endpoint was observed in 3/155 patients (1.9%). Transoesophageal echocardiography and/or CCTA 67 ± 26 days after the procedure showed no device embolization and no device-related thrombus, 24/151 (15.9%) patients showed peri-device gaps of <5 mm while gaps of >5 mm have been observed in 3/151 (2.0%). Among 137/155 patients with available arrhythmia, a follow-up >6 months at 78.1% showed sinus rhythm.
CONCLUSION: In this large multicentre study, concomitant PFA-based AF ablation and LAA closure proved to be feasible, effective, and safe and overall procedure duration was short.