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Updated: May 10, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous endocardial occlusion of incompletely surgically ligated left atrial appendage
Arash Aryana1, Diogo Cavaco, Arvin Arthur
1Regional Cardiology Associates, Sacramento, California, USA; Mercy Heart & Vascular Institute, Sacramento, California, USA.
Insights
Percutaneous endocardial occlusion effectively treats incompletely ligated left atrial appendages (ISLL) after surgery for atrial fibrillation (AF). This novel approach shows promise in preventing thromboembolic events in high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Surgical left atrial appendage ligation is standard for mitral valve surgery and atrial fibrillation (AF) treatment.
- Incomplete surgical ligation (ISLL) can lead to thrombus formation and thromboembolic events.
- A novel percutaneous endocardial occlusion technique for ISLL is presented.
Purpose of the Study:
- To describe a novel percutaneous endocardial occlusion approach for ISLL.
- To evaluate the feasibility and initial outcomes of this technique.
Main Methods:
- Seven patients with AF and ISLL underwent percutaneous endocardial ISLL occlusion.
- An Amplatzer Septal Occluder device was used, guided by fluoroscopy and transesophageal echocardiography.
- Patients received oral anticoagulation therapy.
Main Results:
- Successful acute and long-term ISLL occlusion was achieved in 6 out of 7 patients.
- No embolic events occurred during a follow-up of 10 ± 2 months in patients with successful occlusion.
- Oral anticoagulation was discontinued in patients with successful occlusion.
Conclusions:
- Percutaneous endocardial occlusion of ISLL is a feasible treatment option.
- The Amplatzer Septal Occluder device can be utilized for this procedure.
- Further studies are needed to confirm long-term safety and efficacy.
Introduction:
Surgical ligation of the left atrial appendage is considered standard of care in patients who undergo mitral valve surgery or as an adjunct to a surgical Maze procedure for treatment of atrial fibrillation (AF). However, several studies have demonstrated that this can result in incompletely surgically ligated left atrial appendage (ISLL) in a significant number of patients. It is believed that ISLL may in turn promote thrombus formation and lead to clinically relevant thromboembolic events. A novel approach for percutaneous endocardial occlusion of ISLL is described.
Methods And Results:
Seven patients with AF and ISLL following prior open-chest, surgical suture ligation in the absence of rheumatic heart disease, underwent percutaneous endocardial ISLL occlusion using an Amplatzer Septal Occluder device guided by fluoroscopy and transesophageal echocardiography through a novel approach. Three patients were diagnosed in the setting of acute embolic stroke, 2 at the time of cardiac arrhythmia ablation and 2 by elective precardioversion transesophageal echocardiography. All patients were treated with oral anticoagulation therapy. Acute and long-term ISLL occlusion was successfully achieved in 6 patients, in whom oral anticoagulation was eventually discontinued without any embolic events during 10 ± 2 months of follow-up.
Conclusion:
Percutaneous endocardial occlusion of ISLL is feasible using an Amplatzer Septal Occluder device. Additional studies are required to evaluate the long-term safety and efficacy of this therapeutic treatment strategy in patients with ISLL.
