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Updated: Apr 25, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous left atrial appendage closure for stroke prevention
Ole De Backer1, Anastasia M Loupis, Nikolaj Ihlemann
1Kardiologisk Afdeling, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. ole.debacker@gmail.com.
Insights
Percutaneous left atrial appendage (LAA) closure offers a safe and effective stroke prevention method for atrial fibrillation (AF) patients at high risk of stroke and bleeding. Further long-term studies are needed for routine clinical recommendation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Oral anticoagulation (OAC) is standard for stroke prevention in atrial fibrillation (AF) but carries a high bleeding risk.
- Percutaneous left atrial appendage (LAA) closure is an alternative for AF patients with contraindications to OAC.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous LAA closure for stroke prevention in high-risk AF patients.
- To describe procedural experience and outcomes in a cohort of AF patients.
Main Methods:
- Percutaneous LAA closure was performed in 42 AF patients with high stroke (CHADS-VASc 4.5±1.4) and bleeding (HAS-BLED 3.7±0.9) risks.
- Intracerebral bleeding history was the primary indication for LAA closure.
Main Results:
- Successful LAA closure was achieved in 41 of 42 patients, with one major gastrointestinal bleeding complication.
- The observed annual stroke and bleeding rate was 2.3%, lower than the predicted rates (5.6% and 7.6%, respectively).
- Incomplete LAA closure occurred in one patient; no device thrombosis was observed during a mean 12.6-month follow-up.
Conclusions:
- Percutaneous LAA closure is a safe and effective strategy for stroke prevention in AF patients with high stroke and bleeding risks.
- Long-term follow-up studies are necessary to support routine clinical adoption of LAA closure.
Introduction:
In atrial fibrillation (AF) patients with an increased stroke risk, oral anticoagulation (OAC) is the standard treatment for stroke prevention. However, this therapy carries a high risk of major bleeding. Percutaneous closure of the left atrial appendage (LAA) is suggested as an alternative option for stroke prevention in AF patients with contraindication(s) for OAC treatment.
Material And Methods:
A total of 42 patients underwent percutaneous LAA closure. In this report, we describe our experience with this procedure.
Results:
The patients treated were AF patients with a high stroke risk (CHADS-VASc 4.5±1.4) and contra-indication(s) for OAC and/or a high bleeding risk (HAS-BLED 3.7±0.9). A history of intracerebral bleeding was the most common reason for LAA closure. Successful implantation was obtained in 41 of 42 patients. One major peri-procedural complication occurred; a major gastrointestinal bleeding immediately after the procedure. The mean duration of follow-up was 12.6 months. Both ischaemic stroke and bleeding occurred in one patient, resulting in an observed annual stroke and bleeding rate of 2.3%. This rate was lower than expected based on the CHADS-VASc (5.6%/year) and HAS-BLED (7.6%/year) for the patient cohort. At echo follow-up, incomplete LAA closure was seen in one case; device thrombosis was not observed.
Conclusion:
Our data confirm that percutaneous LAA closure can be a safe and effective strategy for stroke prevention in AF patients with an increased stroke and bleeding risk. However, long-term follow-up studies are needed before this procedure can be recommended for routine clinical use.
Funding:
Grant funding was received (St Jude Medical) for research, but there are no other competing interests.
Trial Registration:
Not relevant.
