Feasibility and Safety of Combined Left Atrial Appendage Occlusion and Catheter Ablation in Persistent Atrial Fibrillation with Left Atrial Appendage Thrombus: The COAT Procedure.

内容摘要

Left atrial appendage thrombus (LAAT) in non-valvular atrial fibrillation (AF) usually precludes catheter ablation and complicates left atrial appendage occlusion (LAAO). Patients with persistent LAAT despite anticoagulation and heart failure have limited rhythm-control options. To describe the feasibility and safety of Combined Occlusion and Ablation therapy for left atrial appendage Thrombus (COAT), a same-session "thrombus-sealing first" strategy, in selected patients with persistent AF, heart failure, and persistent LAAT despite therapeutic OAC. This single-center retrospective proof-of-concept cohort included five patients who underwent COAT between January 2022 and April 2026. LAAO was performed first using a no-touch thrombus-trapping technique. Catheter ablation was performed after device release, confirmation of device stability and sealing, and absence of neurological abnormality. Follow-up included imaging and rhythm surveillance with electrocardiography and Holter monitoring. All five procedures were completed successfully, with first-attempt device deployment and pulmonary vein isolation in all patients. Sinus rhythm was restored in all patients. No periprocedural stroke, transient ischemic attack, systemic embolism, major bleeding, pericardial tamponade/effusion, device embolization, or death occurred. At a median imaging follow-up of 58 days, TEE confirmed complete LAA sealing without device-related thrombus in four patients; one patient declined TEE and cardiac CTA. The four patients with TEE follow-up were transitioned from anticoagulation to lifelong single antiplatelet therapy (SAPT). No thromboembolic or major bleeding events occurred. Four patients remained arrhythmia-free. In this small, selected proof-of-concept cohort, COAT appeared feasible and was not associated with observed major complications. Larger prospective studies are required.