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Updated: Jun 18, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Should patients undergoing cardiac surgery with atrial fibrillation have left atrial appendage exclusion?
Alan G Dawson1, Sanjay Asopa, Joel Dunning
1Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK. alan.g.dawson.04@aberdeen.ac.uk
Insights
Left atrial appendage (LAA) exclusion during cardiac surgery for atrial fibrillation (AF) lacks clear benefits. Current evidence suggests LAA occlusion may not improve outcomes and could potentially increase risks, warranting further investigation.
Area of Science:
- Cardiovascular Surgery
- Electrophysiology
- Medical Technology Assessment
Background:
- Atrial fibrillation (AF) is common in patients undergoing cardiac surgery.
- The left atrial appendage (LAA) is a primary source of thrombi in AF patients.
- LAA exclusion is a potential strategy to reduce stroke risk in these patients.
Purpose of the Study:
- To evaluate the evidence for left atrial appendage (LAA) exclusion in patients undergoing cardiac surgery with atrial fibrillation (AF).
- To determine if LAA occlusion improves clinical outcomes and reduces stroke risk.
Main Methods:
- A structured review of best evidence was conducted.
- A systematic search identified 310 relevant papers, with 12 selected for in-depth analysis.
- Included studies comprised five clinical trials, including one randomized controlled trial, involving approximately 1400 patients.
Main Results:
- The five LAA occlusion trials showed no clear benefit; only one demonstrated a statistical advantage.
- Three studies yielded neutral results, and one reported a significantly increased risk associated with LAA occlusion.
- Successful occlusion rates varied widely, with some methods achieving only 55-66% success, potentially impacting efficacy.
Conclusions:
- Current evidence is insufficient to support routine LAA occlusion during cardiac surgery for AF.
- Incomplete LAA exclusion may pose a risk of harm, outweighing potential benefits.
- Further research is needed to clarify the role and optimal methods of LAA occlusion.
Abstract:
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Should patients undergoing cardiac surgery with atrial fibrillation (AF) have left atrial appendage (LAA) exclusion?' Altogether 310 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that despite finding five clinical trials including one randomised controlled trial, that studied around 1400 patients who underwent LAA occlusion, the results of these studies do not clearly show a benefit for appendage occlusion. Indeed of the five studies, only one showed a statistical benefit for LAA occlusion, with three giving neutral results and in fact one demonstrating a significantly increased risk. One reason for this may be the inability to achieve acceptably high rates of successful occlusion on echocardiography when attempting to perform this procedure. The highest success rate was only 93% but most studies reported only a 55-66% successful occlusion rate when attempting closure in a variety of methods including stapling, ligation and amputation. Currently, the evidence is insufficient to support LAA occlusion and may indeed cause harm especially if incomplete exclusion occurs.
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