Efficacy of Left Atrial Appendage Closure and Oral Anticoagulation After Atrial Fibrillation Catheter Ablation

•Post-ablation LAAC is noninferior to OAC in stroke and MACE events prevention.•Post-ablation LAAC reduce major bleeding and all-cause death by comparing to OAC.•Patients could be OAC-free after AF ablation in the era of LAAC. Left atrial appendage closure (LAAC) proved to be non-inferior to oral anticoagulation (OAC) in non-ablated patients with atrial fibrillation (AF). This study aimed to compare the efficacy and safety of LAAC with OAC therapy in patients after AF ablation. This study included patients who underwent catheter ablation (CA) of AF between January 2016 and December 2020. The cohort was divided into CA+LAAC and CA+OAC, where propensity score matching was used to select controls and each group contained 682 subjects. The enrolled patients’ mean age was 70.34±8.32 years, and 47.3% were female; their CHA2DS2-VASc score was 3.48±1.17. Baseline characteristics were similar between groups. After a 3-year mean follow-up, the incidence of thromboembolic events was 1.25, and 1.10 and that of major bleeding events was 0.65, and 1.72 per 100 patient-years in the CA+LAAC, and CA+OAC groups, respectively. The rate of thromboembolisms and major adverse cardiovascular events was similar between the two groups (hazard ratio [HR], 1.162; 95% confidence interval [CI], 0.665-2.030; P=0.598; HR, 0.711; 95% CI, 0.502–1.005; P=0.053); however, that of major bleeding and all-cause death was significantly reduced with LAAC (HR, 0.401; 95% CI, 0.216–0.746; P=0.004; HR, 0.528; 95% CI, 0.281–0.989; P=0.046). There was no significant difference in peri-procedural complications (P > 0.05) and the rate of AF recurrence (OAC vs. LAAC: 39.44% vs. 40.62%; P=0.658). LAAC is a reasonable and safer alternative to OAC therapy in high-risk patients after AF ablation.