Atrial Fibrillation Recurrence After Left Atrial Appendage Occlusion in Patients Undergoing Atrial Fibrillation Ablation: Lessons from The OPTION Trial (JCEP February 2026)-Article: Atrial Fibrillation Recurrence After Left Atrial Appendage Occlusion in Patients Undergoing Atrial Fibrillation Ablation: Lessons from The OPTION Trial

Article: Atrial Fibrillation Recurrence After Left Atrial Appendage Occlusion in Patients Undergoing Atrial Fibrillation Ablation: Lessons from The OPTION Trial

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This prespecified subanalysis of the randomized, multicenter OPTION trial examined whether left atrial appendage closure (LAAC) performed concomitantly with, or sequentially after, atrial fibrillation (AF) ablation influences AF recurrence and clinical outcomes. The analysis included 1,600 moderate- to high-stroke-risk patients (CHA₂DS₂-VASc ≥2 in men, ≥3 in women) randomized 1:1 to LAAC with the Watchman FLX device versus continued oral anticoagulation (OAC) without a device, with follow-up to 36 months.<br /><br />Overall, 803 patients underwent LAAC (41% concomitant, 59% sequential) and 797 received OAC only. AF recurrence—assessed by implantable device interrogation when available and by ECG/clinical rhythm interventions otherwise—occurred in 830 patients (52%). At 36 months, recurrence rates were not significantly different between groups (LAAC 49.2% vs OAC 45.5%; P=0.08). Recurrence was also similar between concomitant and sequential LAAC strategies (approximately 44% each; no significant difference). Rates of downstream rhythm-control interventions (repeat ablation, cardioversion, antiarrhythmic drug escalation) were comparable across treatment arms.<br /><br />Multivariable analysis identified persistent AF and longer AF duration as the only independent predictors of AF recurrence; LAAC timing/strategy was not predictive. Stroke/systemic embolism rates were low and did not differ meaningfully by AF recurrence status, underscoring that thromboembolic risk can persist even without documented AF recurrence. Safety outcomes showed that among patients without AF recurrence, LAAC was associated with lower non–procedure-related major or clinically relevant nonmajor bleeding than OAC.<br /><br />The main conclusion is that LAAC—whether performed concomitantly or sequentially—does not worsen AF ablation rhythm outcomes, while stroke/systemic embolism risk remains non-negligible regardless of recurrence status.

Keywords

OPTION trial

left atrial appendage closure

LAAC

atrial fibrillation ablation

Watchman FLX

oral anticoagulation

AF recurrence

concomitant vs sequential LAAC

stroke systemic embolism

bleeding outcomes