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Updated: May 8, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage closure followed by 6 weeks of antithrombotic therapy: a prospective single-center experience
K R Julian Chun1, Stefano Bordignon, Verena Urban
1Medizinische Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Frankfurt am Main, Germany.
Insights
This study compared two left atrial appendage (LAA) closure systems in high-risk atrial fibrillation patients, finding both effective with similar procedural outcomes. A 6-week antithrombotic regimen followed by aspirin showed promise for stroke prevention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Limited comparative data exists for available left atrial appendage (LAA) closure systems used for stroke prevention in nonvalvular atrial fibrillation.
- Two contemporary LAA closure systems are currently available.
Purpose of the Study:
- To prospectively compare procedural outcomes and patient results for two LAA closure systems.
- To evaluate an alternative antithrombotic treatment regimen in high-risk patients unsuitable for oral anticoagulation.
Main Methods:
- Eighty high-risk nonvalvular atrial fibrillation patients were enrolled, receiving either Watchman (Group A) or Amplatzer Cardiac Plug (Group B) devices.
- All patients underwent a 6-week antithrombotic therapy, followed by aspirin if transesophageal echocardiography was clear.
- Procedural data, patient characteristics, and clinical outcomes were compared between the two device groups.
Main Results:
- High success rates for LAA closure were achieved (98%), with no significant differences in procedural time or fluoroscopy time between groups.
- Patient characteristics (CHA2DS2VASC, HASBLED scores) were similar between groups.
- During a median 364-day follow-up, no systemic embolism occurred, though 3 deaths (heart failure, bleeding) were reported. Device-related thrombi were detected in 4 patients after 6 weeks.
Conclusions:
- Both left atrial appendage closure devices can be implanted successfully in high-risk patients.
- A 6-week antithrombotic therapy followed by aspirin warrants further investigation in larger studies for safety and efficacy.
Background:
Currently, 2 different left atrial appendage (LAA) closure systems are available for stroke prevention in nonvalvular atrial fibrillation but comparative data are lacking.
Objectives:
To prospectively compare procedural data and patient outcome for 2 contemporary LAA closure systems and to investigate an alternative antithrombotic treatment regimen in high-risk patients.
Methods:
Patients with nonvalvular atrial fibrillation, with high risk for stroke, and who either had contraindication or were not willing to accept oral anticoagulation were prospectively enrolled. Watchman (Boston Scientific, Natick, MA; group A) or Amplatzer Cardiac Plug (St Jude Medical, Minneapolis, MN; group B) devices were implanted. All patients received antithrombotic therapy for 6 weeks. After repeat transesophageal echocardiography, patients were switched to aspirin.
Results:
Eighty patients were enrolled. There was no statistical difference in patient characteristics in groups A and B: CHA2DS2VASC score: 4.1 ± 1.5 versus 4.5 ± 1.8; HASBLED score: 3.1 ± 1.1 versus 3.1 ± 1.1, respectively. LAA closure was achieved in 78 of 80 patients (98%) (group A: 38 of 40 [95%] vs group B: 40 of 40 [100%]). There was no difference in procedure time (group A: 48 ± 16 minutes vs group B: 47 ± 15 minutes; P = .69) and fluoroscopy time (group A: 6.0 ± 4.7 minutes vs group B: 7.3 ± 4.4 minutes; P = .25). Major complications included 1 air embolism and delayed tamponade in each group. After 6 weeks, 1 device dislodgment and 4 device-related thrombi were detected. Ninety-four percent of the patients (73 of 77) were switched to aspirin after 6 weeks. During a median follow-up of 364 days (Q1-Q3: 283-539 days), no systemic embolism occurred, but 3 patients died (heart failure: n = 2; bleeding: n = 1).
Conclusions:
Implantation of both LAA closure devices can be performed with high success rates in high-risk patients. Postprocedural 6 weeks antithrombotic therapy followed by aspirin therapy needs to be confirmed in a larger study.
