ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1604268
Direct Current Cardioversion of Atrial Fibrillation in Patients With Left Atrial Appendage Occlusion Devices
Provisionally accepted
Xin Xie
Zijun Chen
Xiaorong Li
Jinbo Yu
Jian Zhou
Dian ChengXuecheng Wang
Yizhang Wu
Baowei ZhangFenghua FanShuo Wang
Bing Yang*- Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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Background and Aims: The data regarding the safety of Direct current cardioversion (DCCV) in patients with left atrial appendage occlusion (LAAO) device and its impact on thrombo-embolic prevention is scarce. This study sought to investigate the impact of DCCV in patients with LAAO devices. Methods: A single center, ambispective cohort included the one-stop procedures (LAAO combined with radiofrequency catheter ablation, RFCA) in which LAAO was performed first was enrolled. DCCVs were performed to restore sinus rhythm after LAAO, and patients were divided into DCCV group and No DCCV group. Safety endpoints included DCCV-related death, device dislodgment, device embolization and major bleeding events. Efficacy endpoints contained all cause death, cardiovascular death, Stroke/ transient ischemic attack and systemic embolism. Results: In cohort, 196 patients (age 72.5±7.4 years, male 51.0%) were enrolled, and 95 patients underwent DCCV after LAAO. No DCCV-related death, device dislodgement, and device embolism was observed. At 12 months, the safety endpoints occurred in 3.2% of the DCCV group versus 6.9% of the no-DCCV group (p=0.238). Similarly, the efficacy endpoints were observed in 1.1% of the DCCV group versus 4.0% of the no-DCCV group (p=0.339). By performing pre-and post-DCCV transesophageal echocardiography (TEE) in the prospective cohort, a significant increase in device diameter at 45° and 90° (p=0.044; 0.027), and an insignificant decline trend of peri-device leak and shoulder at 135° were noted (p=0.051; 0.103). Conclusions: No signal of excess risk was observed when performing DCCV in patients with LAAO device. Tiny changes in device diameter after DCCV were noted by TEE at 45° and 90°, while not associated with adverse effects.
Keywords: Atrial Fibrillation, Left atrial appendage occlusion, Radiofrequency ablation, One-stop procedure, Direct current cardioversion
Received: 01 Apr 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Xie, Chen, Li, Yu, Zhou, Cheng, Wang, Wu, Zhang, Fan, Wang and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bing Yang, bingyang@tongji.edu.cn
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