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Updated: Jul 6, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous transcatheter left atrial appendage exclusion in atrial fibrillation
Paul T L Chiam1, Carlos E Ruiz
1Lenox Hill Heart and Vascular Institute of New York, 130 East 77th Street, 9th Floor Blackhall, New York, NY 10075, USA.
Insights
Atrial fibrillation (AF) increases stroke risk. Excluding the left atrial appendage (LAA) may prevent strokes, with new minimally invasive methods emerging, though oral anticoagulation remains the standard care.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Stroke is a leading cause of death and disability globally.
- Atrial fibrillation (AF) significantly elevates stroke risk.
- Current oral anticoagulation therapy for AF has limitations including bleeding risk and underutilization.
Purpose of the Study:
- To review the role of left atrial appendage (LAA) exclusion in stroke prevention for AF patients.
- To discuss emerging percutaneous transcatheter techniques for LAA exclusion.
- To compare LAA exclusion strategies with current oral anticoagulation therapy.
Main Methods:
- Review of existing literature on LAA thrombus formation and stroke in AF.
- Analysis of retrospective surgical data on LAA exclusion during mitral valve replacement.
- Summary of initial results from percutaneous LAA exclusion devices (PLAATO, Watchman, Amplatzer Septal Occluder).
Main Results:
- The LAA is a primary source of thrombus in non-rheumatic AF.
- Surgical LAA exclusion during mitral valve replacement showed reduced embolic events.
- Percutaneous LAA exclusion techniques have demonstrated encouraging initial outcomes.
Conclusions:
- LAA exclusion presents a promising strategy for stroke risk reduction in AF.
- Minimally invasive percutaneous techniques offer alternatives to oral anticoagulation.
- Oral anticoagulation remains the established standard of care pending results from ongoing randomized trials.
Abstract:
Stroke is one of the leading causes of mortality, morbidity and serious disability in the developed world. Atrial fibrillation (AF), one of the most common cardiac arrhythmias, is a well-known predisposing factor for stroke, raising the risk significantly. Oral anticoagulation with warfarin is currently the most effective therapy for stroke risk reduction; however, this therapy increases the risk of bleeding and is often underutilized, contraindicated, or when administered, often subtherapeutic. It has been documented that the left atrial appendage (LAA) is the main source of left atrial thrombus, especially in non-rheumatic AF. Therefore, LAA exclusion may reduce the risk of stroke in AF, and retrospective surgical data have demonstrated a reduced risk of embolic events if surgical LAA exclusion was also performed during mitral valve replacement. Recently, several less invasive percutaneous transcatheter techniques of LAA exclusion - the PLAATO device, the Watchman device, and the Amplatzer Septal Occluder - have been employed with initially encouraging results. There is currently an ongoing randomized trial comparing percutaneous LAA exclusion to long-term oral anticoagulation therapy. Until such data are available, however, oral anticoagulation should remain the standard of care for stroke prevention in patients with AF.
