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Updated: Jul 13, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage closure for stroke prevention in atrial fibrillation: state of the art and current challenges
Tariqshah M Syed1, Jonathan L Halperin
1Department of Cardiology, Zena and Michael A Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
Insights
Atrial fibrillation (AF) increases stroke risk. Left atrial appendage (LAA) occlusion offers an alternative stroke prevention method for patients unable to use anticoagulants long-term.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Atrial fibrillation (AF) is a primary risk factor for ischemic strokes.
- Anticoagulation therapy is effective for stroke prevention but not tolerated by all patients.
- Thrombus formation in the left atrial appendage (LAA) is a common source of AF-related strokes.
Purpose of the Study:
- To review the role of the LAA in AF-related embolic stroke.
- To discuss LAA occlusion as a stroke prevention strategy.
- To evaluate LAA occlusion devices for patients intolerant to anticoagulation.
Main Methods:
- Review of current literature on LAA and stroke prevention.
- Discussion of surgical and thoracoscopic LAA exclusion techniques.
- Analysis of percutaneous LAA occlusion device trials.
Main Results:
- Surgical LAA exclusion is performed during open-heart surgery.
- Thoracoscopic LAA occlusion shows promising early outcomes.
- Percutaneous LAA occlusion devices require further safety and efficacy data.
Conclusions:
- LAA occlusion is a viable stroke prevention strategy for select AF patients.
- Further research is needed for percutaneous LAA occlusion devices.
- LAA occlusion offers an alternative for patients who cannot tolerate anticoagulation.
Abstract:
Atrial fibrillation (AF) is a major risk factor for disabling ischemic strokes. Anticoagulation is highly effective for stroke prevention in patients with AF, but a substantial number of patients are unable to sustain chronic therapy with warfarin. Most strokes in patients with AF are thought to arise from thrombus formation in the left atrial appendage (LAA); therefore, occlusion of the orifice of the LAA provides a theoretically appealing option for stroke prevention. Surgical exclusion of the LAA is increasingly performed in patients undergoing open-heart surgery, and thoracoscopic epicardial occlusion of the LAA has yielded promising early results. Percutaneous LAA occlusion devices have shown some success initial trials, but additional safety and efficacy data are required before this approach can be routinely considered. Here we discuss the LAA in relation to AF-related embolic stroke, and how LAA occlusion devices could be used in stroke prevention in patients who cannot tolerate chronic anticoagulant therapy.
