Aim We evaluated the feasibility, safety, and impact of the use of fused computed tomography-digital subtraction angiography (CT-DSA)-guided imaging in catheter ablation (CA) combined with left atrial appendage occlusion (LAAO) on left heart function.

Methods This single-center retrospective study was conducted from July 1, 2023, to December 30, 2023, at the First Affiliated Hospital of Guangzhou University of Chinese Medicine. This study included patients who received combined CA and LAAO (combined group) or CA alone (CA-only group). The primary outcome was perioperative complications within 7 days of surgery, and the secondary outcomes included the results of the 6-month follow-up and the echocardiographic evaluation of left heart function.

Results The procedures were successfully completed for the combined (n=40) and CA-only (n=55) groups, with no significant differences in perioperative complications (P > 0.05). The atrial fibrillation-free rates were similar between the combined and CA-only groups at the 6-month follow-up, (70% vs. 74.5%, P = 0.623). The left atrial anteroposterior diameter (LAAD) was significantly lower at 6 months (preoperative: 46.32 ± 5.14 mm vs. 6 months: 42.13 ± 5.94 mm, P < 0.05), and left ventricular ejection fraction (LVEF) increased but was not statistically significant (P = 0.059) in the combined group than prior to surgery, while the LVEF significantly increased in the CA-only group (P < 0.05). The increase in LVEF was statistically significant in the CA-only group 6 months after surgery compared with LVEF prior to surgery (P < 0.05). The left ventricular filling pressure (E/E') significantly increased in the combined group post-surgery (P < 0.05) compared to the pressure before surgery.

Conclusions CA combined with LAAO guided by fused CT-DSA imaging is a safe and feasible treatment option for selected patients with atrial fibrillation. Furthermore, the combined procedure has no significant impact on left ventricular systolic function.