The Impact of Atrial Pressure Change Before and After Combined Procedure

1. Study aim. This study was designed to measure the left and right atrial pressure change before and after catheter ablation (CA) and left atrial appendage closure (LAAC) combining procedure, and investigate the influence of the pressure change on clinical outcomes. 2. Subject selection. This study is designed to recruit patients diagnosed with atrial fibrillation and planned to undergo combined procedure. Primary inclusion criteria are:

i. Atrial fibrillation recorded by 12-lead ECG or Holter that last for longer than 30 seconds within the preceding 6 months; ii. Eligible for left atrial appendage closure, that meet at least one of the followings: 1. At high risk of stroke (CHA2DS2-VASc score≥3 in female, ≥2 in male) and/or bleeding (HAS-BLED score≥3); 2. Contraindicated to oral anticoagulation (OAC); 3. Refused OAC treatment albeit comprehensively informed of the necessity and benefits of OAC treatment. 3. Procedure detail. All the patients recruited is planned to undergo combined procedure. CA is performed before LAAC. For CA, the energy source is optional (either radiofrequency or cryoenergy). And ablation should be performed for pulmonary vein isolation only. For LAAC, the occluder type is optional (either plug or pacifier occluder), and intracardiac echocardiography or transesophageal echocardiography (TEE) is optional.

For atrial pressure measurement, right atrial pressure should be measured before transseptal puncture and after combined procedure is accomplished. Left atrial pressure should be measured at 3 timepoints: after transseptal puncture, after pulmonary vein isolation and after LAAC. Atrial pressure is measured via Swartz transseptal puncture sheath. And at each timepoint, atrial pressure should be recorded at 1min, 3min, and 5min after the placement of the sheath. 4. Follow-up. study endpoint includes a primary composite endpoint of rehospitalization due to heart failure and death due to cardiovascular disease, and secondary endpoints including: 1. all-cause mortality 2. major cardiovascular adverse event 3. rehospitalization due to cardiovascular diseases 4. recurrence of atrial arrhythmia 5. stoke/transient ischemic attack 6. echocardiographic measurement 7. quality of life evaluation 8. cardiac function evaluation 9. evaluation of left atrial appendage closure. Patients are required to have outpatient follow-up at 3rd month, 12th month, and every year since then. The anti-thromboembolic regimen should follow: 3-month OAC treatment and 3-month double anti-platelet therapy and lifelong single anti-platelet therapy. For LAAC follow-up, either TEE or CTA is scheduled to perform in the 3rd month after procedure.

• All-cause mortality [Срок оценки: From date of inclusion until the date of documented death of any reason, assessed up to 60 months]
• Major cardiovascular adverse event [Срок оценки: From date of inclusion until the date of first documented cardiovascular events mentioned above, assessed up to 60 months]
• Rehospitalization due to cardiovascular diseases [Срок оценки: From date of inclusion until the date of first documented rehospitalization due to cardiovascular diseases, assessed up to 60 months]
• Early recurrence of atrial arrhythmia [Срок оценки: From time of completion of combined procedure until the third month since the procedure]
• Recurrence of atrial arrhythmia [Срок оценки: From the third month since the procedure until the date of recurrence of atrial arrhythmia as described above, assessed up to 60 months]
• Stoke/transient ischemic attack [Срок оценки: From date of inclusion until the date of first documented stoke/transient ischemic attack, assessed up to 60 months]
• Change from baseline echocardiographic measurement at 3 months [Срок оценки: 3 months after combined procedure]
• Change from baseline echocardiographic measurement at 1 year [Срок оценки: 1 year after combined procedure]
• Change from baseline echocardiographic measurement at 5 years [Срок оценки: 5 years after combined procedure]
• Change from baseline quality of life evaluation at 3 months [Срок оценки: 3 months after combined procedure]
• Change from baseline quality of life evaluation at 1 year [Срок оценки: 1 year after combined procedure]
• Change from baseline quality of life evaluation at 5 years [Срок оценки: 5 years after combined procedure]