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Updated: May 26, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous left atrial appendage closure for stroke prevention in atrial fibrillation
M J Swaans1, M C Post, B J W M Rensing
1Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands, m.swaans@antoniusziekenhuis.nl.
Insights
Percutaneous left atrial appendage (LAA) closure offers a new treatment option for atrial fibrillation (AF) patients at high risk of stroke or bleeding. Initial results show successful LAA closure, providing an alternative to long-term coumadin therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Atrial fibrillation (AF) patients often face high risks of thromboembolic events or bleeding complications.
- Coumadin therapy is a standard treatment but carries risks and limitations.
- Percutaneous left atrial appendage (LAA) closure presents a novel alternative for select patient populations.
Purpose of the Study:
- To evaluate the initial clinical experience and feasibility of percutaneous LAA closure.
- To assess the safety and efficacy of LAA device implantation in high-risk AF patients.
- To determine if LAA closure can serve as an alternative to chronic coumadin therapy.
Main Methods:
- Patients with AF and high stroke risk (CHADS(2) score >1) or coumadin contraindications were included.
- Procedures were performed under general anesthesia with fluoroscopic and transesophageal echocardiography (TEE) guidance.
- Device placement success, procedural time, and complications were recorded. Follow-up TEE at 45 days assessed LAA occlusion.
Main Results:
- Percutaneous LAA closure was successfully performed in 10 high-risk AF patients (median CHADS(2) score 3).
- The device was successfully placed in all patients within a median of 56 minutes.
- No thromboembolic events occurred at 45-day follow-up; one patient experienced device dislocation requiring retrieval.
Conclusions:
- Percutaneous LAA closure is a feasible alternative to chronic coumadin therapy for high-risk AF patients.
- The technique demonstrates potential for reducing stroke and bleeding risks associated with AF.
- Further studies are warranted to confirm long-term outcomes and safety profiles.
Background:
Percutaneous left atrial appendage (LAA) closure can be an alternative to coumadin treatment in patients with atrial fibrillation (AF) at high risk for thromboembolic events and/or bleeding complications. We report the initial experience with this new technique.
Methods:
Patients were eligible if they had AF with a high stroke risk (CHADS(2) score >1), and/or contraindication for coumadin therapy. The procedure was performed under general anaesthesia, using biplane fluoroscopy and (3D) transoesophageal echocardiography (TEE) guidance. Patients were discharged on coumadin until a TEE was repeated at 45 days after closure to evaluate LAA occlusion. If LAA occlusion was achieved, oral anticoagulation was discontinued and aspirin started.
Results:
Percutaneous LAA closure was performed in 10 patients (50% male, age 61.6 ± 9.6 years). The median CHADS(2) score was 3 (range 2-4), median CHA(2)DS(2)-VASc score 3.5 (range 2-6) and HAS-BLED score 1.5 (range 1-4). Nine patients had a history of stroke and 2 patients had a history of major bleeding while on coumadin. Concomitant pulmonary vein isolation was performed in 9 patients. The device was successfully placed in all patients within a median of 56 min (38-137 min). Asymptomatic catheter thrombus occurred in one patient. At 45-day follow-up, no thromboembolic events occurred, TEE showed minimal residual flow in the LAA in three patients. In one patient the LAA device was dislocated, requiring successful percutaneous retrieval.
Conclusion:
Device closure of the LAA may provide an alternative strategy to chronic coumadin therapy in patients with AF and high risk of stroke and/or bleeding complications using coumadin.
