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Updated: May 2, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous methods of left atrial appendage exclusion: an alternative to the internist
Duong L Le1, Soidjon D Khodjaev1, Remo L Morelli1
1Department of Internal Medicine, St Mary's Medical Center, San Francisco, CA, USA.
Insights
For patients with atrial fibrillation (AF) intolerant to oral anticoagulation (OAC), left atrial appendage (LAA) occlusion offers a promising alternative for stroke risk reduction. This review highlights percutaneous LAA occlusion devices as a viable strategy for stroke prophylaxis.
Area of Science:
- Cardiology
- Medical Devices
- Stroke Prevention
Background:
- Thromboembolic stroke from the left atrial appendage (LAA) is a significant risk for patients with atrial fibrillation (AF).
- Oral anticoagulation (OAC) is the standard stroke reduction therapy, but is limited by compliance issues, narrow therapeutic windows, and bleeding risks.
- A substantial portion of AF patients are not on OAC due to contraindications or physician/patient reluctance, creating a therapeutic dilemma.
Purpose of the Study:
- To review current literature on alternative stroke reduction strategies for AF patients.
- To highlight percutaneous left atrial appendage (LAA) occlusion as an alternative for patients intolerant to OAC.
- To bring attention to emerging LAA occlusion devices for stroke prophylaxis.
Main Methods:
- Literature review of percutaneous LAA occlusion devices.
- Analysis of current evidence for stroke prophylaxis in AF patients.
- Discussion of devices like Amplatzer Cardiac Plug, WATCHMAN, and LARIAT.
Main Results:
- Percutaneous LAA occlusion has emerged as a viable alternative to OAC for stroke risk reduction in AF.
- Devices such as WATCHMAN and Amplatzer Cardiac Plug are under investigation for stroke prophylaxis.
- The LARIAT device may offer stroke prophylaxis without requiring short-term post-procedural OAC.
Conclusions:
- Left atrial appendage (LAA) occlusion presents a significant alternative for managing stroke risk in AF patients who cannot tolerate OAC.
- Percutaneous LAA occlusion devices offer a new dimension in managing chronic AF, particularly for high-risk, OAC-intolerant individuals.
- Further research and clinical adoption of LAA occlusion devices are warranted to improve stroke prevention in AF.
Abstract:
Thromboembolic stroke from the left atrial appendage (LAA) is the most feared complication in patients with atrial fibrillation (AF). The cornerstone for the management of chronic non-valvular AF is stroke reduction with oral anticoagulation (OAC). However, poor compliance, maintaining a narrow therapeutic window, and major side effects such as bleeding have severely limited their use, which creates a therapeutic dilemma. As much as 20% of AF patients are not receiving OAC due to contraindications and less than half of AF patients are not on OAC due to reluctance of the prescribing physician and/or patient non-compliance. Fortunately, over the past decade, there have been great interests in providing an alternative strategy unbeknownst to the practicing internist. The introduction of percutaneous approaches for LAA occlusion has added a different dimension to the management of chronic AF in patients with OAC intolerance. Occlusion devices such as the Amplatzer Cardiac Plug and WATCHMAN device are currently being investigated for stroke prophylaxis. More recently, the LARIAT device may provide an alternative means for potential stroke prophylaxis without the need for short-term post-procedural OAC. We aim to review the current literature and bring attention to an alternative strategy for high-risk AF patients intolerant to OAC.
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