Background Emerging evidence suggests that a combined approach with left atrial appendage occlusion (LAAO) and catheter ablation (CA) may be a safe, effective alternative for patients with atrial fibrillation (AF) at high risk of bleeding and stroke. Objective This review seeks to systematically evaluate the safety and efficacy of this combined approach, addressing gaps in the current evidence. Methods A systematic search of PubMed, Science Direct, and Cochrane Central Register of Clinical Trials (CENTRAL) was performed for studies that reported outcomes comparing CA and LAAO vs. CA without LAAO. The Review Manager 5.4 software was utilized to conduct a meta-analysis of the outcomes. Results Six studies of 3,770 patients with AF, of whom 1778 underwent LAAO after CA vs. 1992 CA, were analyzed. After a mean follow-up of 30 months, the combined approach was associated with a significantly lower risk of major bleeding compared to CA alone (OR 0.45; 95% CI 0.26-0.78; p <0.0001). There were no differences in stroke or systemic embolism rates between groups (OR 1.00; 95% CI 0.66–1.52; p = 0.91), and no significant difference was observed in all-cause mortality (OR 0.77; 95% CI 0.34–1.74; p = 0.35). Conclusion This meta-analysis suggests that a combined approach is associated with a reduction in major bleeding while demonstrating non-inferiority in thromboembolic events and mortality compared to CA alone. Further randomized clinical trials are needed to confirm these findings.