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Updated: May 1, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage exclusion-Where do we stand?
Timothy Sakellaridis1, Mihalis Argiriou1, Christos Charitos1
11 Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 2 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 3 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 5 Internal Medicine Department, "Theageneio" Anticancer Hospital, Thessaloniki, Greece ; 6 Cardiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece ; 7 Anesthisiology Department, "Saint" Luke Private Hospital, Thessaloniki, Panorama, Greece.
Insights
Left atrial appendage (LAA) exclusion offers an alternative stroke prevention method for patients with atrial fibrillation (AF) unsuitable for oral anticoagulation. Mechanical LAA closure demonstrates feasibility and efficacy in preventing thromboembolic events.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Atrial fibrillation (AF) is a prevalent cardiac arrhythmia associated with a high risk of stroke, primarily from left atrial appendage (LAA) thrombi.
- Oral anticoagulation (OAC) with vitamin-K antagonists is standard for stroke prevention but has contraindications and limitations for many AF patients.
Purpose of the Study:
- To review the evidence and results of mechanical left atrial appendage (LAA) exclusion as an alternative to OAC for stroke prevention in patients with non-valvular AF.
Main Methods:
- Review of current evidence on LAA exclusion techniques, including surgical, thoracoscopic, and percutaneous transcatheter approaches.
- Analysis of studies evaluating dedicated LAA exclusion devices like PLAATO, Watchman, and Amplatzer cardiac plug.
Main Results:
- Percutaneous transcatheter LAA exclusion devices show encouraging feasibility and efficacy.
- High rates of successful implantation have been reported for these devices.
- LAA exclusion serves as a viable alternative to OAC for selected AF patients.
Conclusions:
- Mechanical LAA exclusion is an effective strategy for preventing thromboembolic events in AF patients.
- Transcatheter LAA occlusion devices offer a promising alternative for patients who cannot tolerate or benefit from OAC.
Abstract:
Atrial fibrillation (AF) is consider to be the most common cardiac arrhythmia with an increasingly prevalence. It is postulated that the source of thromboembolism in 90% of patients with non-valvular AF arises from the left atrial appendage (LAA). Stroke is the most feared and life threatening consequence of thromboembolism. Oral anticoagulation (OAC) with vitamin-K-antagonists is the standard medical therapy for stroke prevention in patients with AF. Unfortunately, chronic therapy with vitamin-K-antagonists is contraindicated in 14% to 44% of patients with AF who are at risk for stroke, and its benefits are limited by underutilization, narrow therapeutic window and increased risk for bleeding, making it often undesired. Therefore, mechanical LAA exclusion is a means of preventing thrombus formation in the appendage and subsequent thromboembolic events in these patients. The LAA can be excluded from the systemic circulation via surgical, percutaneous, or thoracoscopic approaches. Several studies of percutaneous transcatheter delivery of dedicated LAA exclusion devices, such as the percutaneous left atrial appendage transcatheter occlusion (PLAATO) device, Watchman device and the Amplatzer cardiac plug, have shown encouraging results as an alternative to vitamin-K-antagonists therapy for selected patients, good feasibility and efficacy, with a high rate of successful implantation. We discuss the current evidence for LAA exclusion in patients and review their results.
