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Updated: Sep 30, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Is left atrial appendage occlusion useful for prevention of stroke or embolism in atrial fibrillation?
C Stöllberger1, J Finsterer, G Ernst
1Krankenanstalt Rudolfstiftung 2. Medizinische Abteilung Juchgasse 25 1030-Wien, Osterreich.
Insights
Eliminating the left atrial appendage (LAA) to prevent stroke in atrial fibrillation patients may cause harm. Current evidence suggests LAA elimination could negatively impact cardiac function and create new stroke risks.
Area of Science:
- Cardiology
- Medical Research
Background:
- Atrial fibrillation (AF) is associated with thrombi formation in the left atrial appendage (LAA), making LAA elimination a potential stroke prevention strategy.
- The LAA is often considered vestigial, but emerging data suggest it plays a role in cardiac function regulation.
Purpose of the Study:
- To evaluate the potential benefits and risks of left atrial appendage elimination as an alternative to oral anticoagulation in atrial fibrillation patients.
- To investigate the physiological role of the LAA in cardiac function and its implications in various cardiovascular conditions.
Main Methods:
- Review of existing animal and human investigation data regarding the function of the LAA.
- Analysis of the potential consequences of LAA elimination on hemodynamic stability and cardiac output.
Main Results:
- The LAA plays a significant role in maintaining cardiac function, particularly in conditions like arterial hypertension, AF, coronary heart disease, valvular heart disease, and heart failure.
- LAA elimination may impair the body's response to hypovolemia and volume/pressure overload, potentially decreasing cardiac output and exacerbating heart failure.
- Instead of preventing stroke, LAA elimination might introduce new stroke risk factors.
Conclusions:
- The physiological and pathophysiological roles of the LAA are not fully understood.
- Left atrial appendage elimination should not be considered a substitute for oral anticoagulation in atrial fibrillation patients due to potential harm.
- Further research is needed to elucidate the complete function of the LAA before considering its elimination.
Abstract:
Since in atrial fibrillation more than 90% of the thrombi are located in the left atrial appendage, an "elimination" of the left atrial appendage, either by resection or occlusion, seems an attractive alternative to oral anticoagulation. Although frequently regarded as an useless appendage, data from animal and human investigations show that the left atrial appendage may play an important role in the maintenance and regulation of the cardiac function, especially in arterial hypertension, atrial fibrillation, coronary heart disease, valvular heart disease and heart failure. Elimination of the left atrial appendage may impede thirst in hypovolemia, deteriorate hemodynamic responses to volume or pressure overload, decrease cardiac output and promote heart failure. Instead of preventing stroke, the consequences of left atrial appendage elimination may create new risk factors for stroke and thus might induce more harm than benefit to patients with atrial fibrillation. As long as the physiologic and pathophysiologic role of the left atrial appendage is not fully understood, left atrial appendage elimination should not be an alternative to oral anticoagulation.
