Related Experiment Video
Updated: May 17, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
[Percutaneous exclusion of the left atrial appendage: perspectives]
P Aubry1, J-M Juliard, E Brochet
1Département de cardiologie, centre hospitalier Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France. pcaubry@yahoo.fr
Insights
Left atrial appendage closure offers a promising alternative to anticoagulation for preventing stroke in atrial fibrillation (AF) patients at high risk for both stroke and bleeding. Further research is needed to clarify its role and optimize patient selection.
Area of Science:
- Cardiology
- Interventional Cardiology
- Stroke Prevention
Background:
- Atrial fibrillation (AF) poses a significant stroke risk, necessitating effective prevention strategies.
- Current oral anticoagulants are effective but limited by bleeding risks, especially in high-risk patients.
- Warfarin is often underutilized in patients with high stroke risk due to bleeding concerns.
Purpose of the Study:
- To explore alternative methods for preventing thromboembolic events in atrial fibrillation patients.
- To evaluate left atrial appendage (LAA) exclusion as a strategy for patients at high risk of both thrombotic and hemorrhagic events.
- To clarify the role and target population for percutaneous LAA exclusion therapy.
Main Methods:
- Review of existing surgical and percutaneous LAA exclusion systems.
- Analysis of data from the PROTECT AF randomized study comparing percutaneous LAA exclusion with warfarin.
- Consideration of factors influencing procedural success and long-term efficacy.
Main Results:
- Percutaneous LAA exclusion demonstrated non-inferiority to warfarin in the PROTECT AF study.
- Surgical LAA exclusion outcomes are dependent on the quality of the exclusion.
- Several percutaneous LAA exclusion systems have been developed over the past decade.
Conclusions:
- Percutaneous LAA exclusion is a viable alternative to anticoagulation for select AF patients.
- Further clarification is needed regarding the optimal target population for this interventional therapy.
- Future efforts should focus on reducing complications, improving occlusion rates, and establishing long-term follow-up protocols.
Abstract:
With its high prevalence and well-known thromboembolic risk, atrial fibrillation (AF) is a crucial component of the 2010-2014 actions plan, ongoing in France to reduce the annual incidence of stroke. The stroke risk is stratified well with the CHA(2)DS(2)-VASc score. With the current guidelines, most patients with AF should be on oral anticoagulant regimen, a treatment recognized as effective but whose bleeding risks limit its use. In clinical practice, warfarin is often not prescribed in patients with high risk of stroke. Thus, the exploration of new ways in preventing thromboembolic events in patients with AF is needed. Beside new more convenient anticoagulant agents, the exclusion of the left atrial appendage recognized as main source of thrombi, may be an alternative in patients with both high risk of thrombotic and haemorrhagic events. Surgical experience showed that the results depend on the quality of the exclusion. For over the past 10 years, several percutaneous exclusion systems of the left atrial appendage have been developed. A randomized study (PROTECT AF) demonstrated the non-inferiority of the percutaneous exclusion in comparison with the warfarin. However, the place of this interventional therapy remains to be clarified, particularly the definition of the target population. This often multidisciplinary approach will have to be accompanied by a reduction of periprocedural complications, increase in rate of complete occlusion, and enough long clinical follow-up to assess the efficiency of this strategy.
Related Concept Videos
01:24Cardiac Catheterization III: Left Heart Catheterization
01:21Cardiac Catheterization II: Right Heart Catheterization