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Background: Catheter ablation (CA) combined with left atrial appendage closure (LAAC) has emerged as a promising method to relieve symptoms while reducing the incidence of stroke in selected high‐risk patients with atrial fibrillation (AF). Hypothesis: We aimed to investigate the clinical outcomes of combined CA and LAAC in elderly patients. Methods: A total of 316 patients with symptomatic drug‐refractory AF who underwent combined CA and LAAC between January 2016 and December 2020 were retrospectively included. Baseline characteristics, periprocedural complications, and clinical events during follow‐up were recorded and compared between patients aged ≥ 75 years (n = 66) and <75 years (n = 250). Results: Pulmonary vein isolation and satisfactory LAAC were achieved in all patients. No patients experienced death or stroke/transient ischemic stroke periprocedurally. After a median follow‐up of 12.2 (6.7−24.4) months and 11.9 (5.5−23.6) months, the rate of sinus rhythm maintenance was comparable between the two groups (≥75 years: 78.8% vs. <75 years: 80.8%; log‐rank test, p = 0.674). The median follow‐up periods for clinical outcomes were 27.9 (9.3−44.8) months and 25.2 (10.8−45.7) months, respectively. In patients aged ≥ 75 years, one suffered ischemic stroke, and one experienced major bleeding event. In patients aged < 75 years, four had ischemic stroke, and eight had major bleeding events. Two patients aged < 75 years died during follow‐up, while none of the patients aged ≥ 75 years died. Conclusions: Combining CA and LAAC was feasible, safe and effective in elderly patients with AF. [ABSTRACT FROM AUTHOR]

Background: The Watchman device is the most widely used occluder but is indicated in atrial fibrillation (AF) patients with a maximal left atrial appendage (LAA) orifice diameter between 17 and 31 mm. We aimed to compare the long‐term safety and efficacy of left atrial appendage closure (LAAC) between patients with a small LAA (<17 mm) and those with an indicated LAA (17–31 mm) measured by transesophageal echocardiography (TEE). Methods: A total of 369 AF patients treated with LAAC between March 2015 and February 2019 were included and divided into two groups based on the maximal LAA orifice diameter measured by TEE: small LAA group (n = 22) and indicated LAA group (n = 347). Periprocedural complications and long‐term clinical outcomes were compared. Results: The Watchman device was successfully implanted in all patients. Mean device compression was higher in the small LAA group. Four patients (1.2%) in the indicated LAA group experienced pericardial effusion, and none experienced pericardial effusion in the small LAA group. Device‐related thrombus was detected in one (4.5%) patient in the small LAA group and five (1.4%) in the indicated LAA group (p =.310). After a mean follow‐up period of 4.1 ± 1.6 years, one patient in the small LAA group (4.5%; 1.1/100 person‐years) and four in the indicated LAA group (1.2%; 0.3/100 person‐years) suffered an ischemic stroke (p =.266). Conclusions: The safety and efficacy of LAAC with the Watchman device were comparable between patients with small and indicated LAA orifice diameters measured by TEE. [ABSTRACT FROM AUTHOR]