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Updated: May 17, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Routine left atrial appendage ligation during cardiac surgery may prevent postoperative atrial fibrillation-related
Ryan Kim1, Norbert Baumgartner, John Clements
1Department of Surgery, Central Michigan University Healthcare, Central Michigan University College of Medicine, Saginaw, MI, USA. ryan.kim@cmich.edu
Insights
Routine left atrial appendage ligation during cardiac surgery significantly reduced the risk of postoperative cerebrovascular accidents in patients with atrial fibrillation. This safe procedure warrants further investigation in larger trials.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Clinical Outcomes
Background:
- Postoperative atrial fibrillation is a common complication following cardiac surgery.
- Atrial fibrillation increases the risk of cerebrovascular accidents (CVAs).
- Left atrial appendage ligation is a potential method to mitigate these risks.
Purpose of the Study:
- To evaluate the efficacy of routine left atrial appendage ligation in preventing postoperative atrial fibrillation-related CVAs.
- To assess the safety and impact of this surgical adjunct.
Main Methods:
- Retrospective chart review of adult cardiac surgery patients (2001-2010).
- Case-control study utilizing propensity score matching for ligation groups.
- Analysis of preoperative risk factors (CHADS2 score) and 30-day postoperative outcomes.
Main Results:
- Matched analysis included 631 patients in each group (ligation vs. no ligation).
- Patients with postoperative atrial fibrillation were more likely to be older and undergo valve surgery.
- Zero CVAs occurred in the ligation group with atrial fibrillation versus 6.1% in the non-ligation group (P = .003).
Conclusions:
- Routine left atrial appendage ligation significantly decreased postoperative CVAs in patients who developed atrial fibrillation.
- Ligation is a safe adjunct to various cardiac procedures.
- Further validation through a large randomized controlled trial is recommended.
Objective:
The aim of the study was to determine whether routine left atrial appendage ligation in cardiac surgery would reduce the risk of postoperative atrial fibrillation-related cerebrovascular accident.
Methods:
We performed an institutional review board-approved, case-control, retrospective chart review of adult patients who underwent cardiac surgery by a single surgeon between January 1, 2001, and December 31, 2010. Preoperative CHADS(2) score criteria were collected, and outcomes through postoperative day 30 were analyzed.
Results:
A total of 2067 patients were reviewed. Propensity score matching was used to create matched groups based on left atrial appendage ligation, and 631 patients were matched in each group. Subjects with postoperative atrial fibrillation were 2.4 times (95% confidence interval, 1.51-2.82) more likely to undergo valve surgery, 2.11 times (95% confidence interval, 1.56-2.86) more likely to be aged more than 75 years, and 1.36 times (95% confidence interval, 1.03-1.80) more likely to have undergone left atrial appendage ligation. In the left atrial appendage ligation group with postoperative atrial fibrillation (n = 145), there were zero subjects (0%) with a postoperative cardiovascular accident. In the non-left atrial appendage ligation group with postoperative atrial fibrillation (n = 115), there were 7 subjects (6.1%) with a postoperative cardiovascular accident (0.0% vs 6.1%, P = .003).
Conclusions:
Although postoperative atrial fibrillation remains a common complication of cardiac surgery, there was a significant decrease in the incidence of postoperative cerebrovascular accidents since routine ligation of the left atrial appendage was undertaken. This has been found to be a safe adjunct to a wide variety of cardiac procedures and therefore deserves further study by a larger randomized controlled trial.
