Safety and Feasibility of Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion at Centers With Versus Without Onsite Cardiothoracic Surgery.

Background: Atrial fibrillation (AF) ablation and left atrial appendage occlusion (LAAO) are traditionally performed in centers with onsite cardiothoracic surgery (CTS), expanding these procedures to centers without CTS (Wo-CTS) raises questions about procedural safety and feasibility.

Objective: To compare the safety and feasibility of AF ablation and LAAO at two centers within the Naples Comprehensive Healthcare (NCH) System in Southwest Florida, one with CTS and the other Wo-CTS.

Methods: A retrospective cohort study was conducted for consecutive patients between March 1, 2023, to May 31, 2025. Baseline demographics, clinical characteristics, and procedural complications were collected. The cardiac tamponade between the two groups was analyzed using Fisher's exact test, and length of stay (LOS) was analyzed using an independent t-test. Patient demographics were analyzed utilizing a t-test and χ² test.

Results: Among 2458 patients (1788 at CTS and 670 at Wo-CTS), baseline comorbidities were similar, except for a higher prevalence of coronary artery disease at CTS. AF ablation patients at Wo-CTS had a 0.5% tamponade rate (3/550), with one requiring surgical repair after transfer. The CTS site had a 0.1% tamponade rate (1/1353, p = 0.075), managed percutaneously. LAAO complications with one hemorrhagic stroke and one device dislodgement at CTS, both managed non-surgically.

Conclusion: This study supports the feasibility of performing AF ablation and LAAO at Wo-CTS centers under defined protocols and by well-trained operators. Further studies are warranted to confirm broader applicability.