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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 left atrial appendage occlusion for stroke prophylaxis in nonvalvular atrial fibrillation: a systematic
Navkaranbir Singh Bajaj1, Akhil Parashar2, Shikhar Agarwal2
1Division of Cardiovascular Disease, University of Alabama, Birmingham, Alabama.
Insights
Percutaneous left atrial appendage (LAA) occlusion shows comparable stroke prevention efficacy to warfarin in nonvalvular atrial fibrillation (NVAF). This systematic review of observational studies confirms safety and effectiveness for LAA occlusion devices.
Area of Science:
- Cardiology
- Interventional Cardiology
- Stroke Prevention
Background:
- Percutaneous left atrial appendage (LAA) occlusion is an alternative to medical management for stroke prevention in nonvalvular atrial fibrillation (NVAF).
- Existing literature on the efficacy and safety of LAA occlusion devices is limited, leading to ongoing controversy.
- A recent randomized trial suggested noninferiority, prompting further investigation into observational data.
Purpose of the Study:
- To systematically review and analyze observational studies on percutaneous LAA occlusion for stroke prophylaxis in NVAF patients.
- To assess the neurological event rates associated with LAA occlusion devices.
- To evaluate the safety and efficacy of LAA occlusion compared to historical anticoagulation strategies.
Main Methods:
- A comprehensive literature search was conducted across Medline, Scopus, and Web of Science databases.
- Included studies involved LAA device implantation in at least 10 patients with a minimum 6-month follow-up.
- Data from 17 eligible studies, totaling 1,107 patients and 1,586.4 person-years of follow-up, were analyzed.
Main Results:
- The adjusted incidence rate for stroke was 0.7/100 person-years (PY), and for transient ischemic attacks (TIAs) was 0.5/100 PY.
- Combined neurological events (stroke or TIA) occurred at a rate of 1.1/100 PY.
- Common procedural complications included access site vascular issues (8.6%) and pericardial effusion (4.3%).
Conclusions:
- Percutaneous LAA occlusion demonstrates comparable efficacy to adjusted-dose warfarin for stroke prevention in NVAF patients.
- The findings suggest that LAA occlusion devices are a viable option for stroke prophylaxis in this population.
- Further research may solidify the role of LAA occlusion in managing NVAF patients at risk for stroke.
Objectives:
The goal of this study was to provide a systematic review and analysis of observational studies on percutaneous left atrial appendage (LAA) occlusion for stroke prophylaxis in nonvalvular atrial fibrillation (NVAF).
Background:
A recent randomized controlled trial in patients with NVAF suggested noninferiority of percutaneous LAA occlusion versus medical management for stroke prevention. However, the use of percutaneous devices remains controversial because of limited literature on their efficacy and safety. We performed a systematic analytical review of existing observational studies to assess the rate of neurological events for patients treated with occlusion devices.
Methods:
A comprehensive search of the Medline, Scopus, and Web of Science databases from inception through August 1, 2013, was conducted using pre-defined criteria. We included studies reporting implantation in at least 10 patients and a follow-up of 6 months or more.
Results:
In 17 eligible studies, a total of 1,052 devices were implanted in 1,107 patients with 1,586.4 person-years (PY) of follow-up. The adjusted incidence rate of stroke was 0.7/100 PY (95% confidence interval [CI]: 0.3 to 1.1/100 PY), of transient ischemic attacks was 0.5/100 PY (95% CI: 0.1 to 1.8/100 PY), and of combined neurological events (strokes or transient ischemic attacks) was 1.1/100 PY (95% CI: 0.6 to 1.6/100 PY). Access site vascular complications and pericardial effusion were the most commonly observed procedural complications at a rate of 8.6% (95% CI: 6.3% to 11.7%) and 4.3% (95% CI: 3.1% to 5.9%), respectively.
Conclusions:
Our systematic review suggested comparable efficacy of LAA occlusion devices compared with historical controls treated with adjusted-dose warfarin and other anticoagulation strategies for prevention of stroke in patients with NVAF.
