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Updated: Apr 24, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Thoracoscopic left atrial appendectomy
Miguel Guerra1, Daniel Martins, José Miranda
1Serviço de Cirurgia Cardiotorácica do Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.
Insights
For patients with atrial fibrillation unsuitable for anticoagulation, left atrial appendage (LAA) closure prevents stroke. Thoracoscopic LAA excision offers a safe alternative when percutaneous closure is not feasible.
Area of Science:
- Cardiology
- Thoracic Surgery
- Medical Devices
Background:
- Oral anticoagulation effectively prevents stroke in non-rheumatic atrial fibrillation.
- Certain patients, due to bleeding risk or prior hemorrhage, cannot tolerate long-term anticoagulation.
- Percutaneous left atrial appendage (LAA) closure is an alternative for stroke prevention in these patients.
Observation:
- A challenging case involved an 82-year-old male with a history of intracerebral hemorrhage.
- The patient's two-lobed LAA anatomy precluded effective percutaneous occlusion.
- This necessitated an alternative strategy to manage thromboembolic risk.
Findings:
- A videothoracoscopic LAA excision was successfully performed.
- This procedure completely removed the LAA, addressing the anatomical limitations for percutaneous closure.
- The approach eliminated the need for oral anticoagulant therapy.
Implications:
- Thoracoscopic LAA excision is a potentially safe and effective alternative to percutaneous closure.
- It provides a viable option for patients at high risk of thromboembolism and intolerance to anticoagulation.
- This surgical technique may be considered for complex LAA anatomies unsuitable for device-based closure.
Abstract:
In patients with non-rheumatic atrial fibrillation, efficacy of stroke prevention with oral anticoagulant therapy has been proved. However, there are patients who are not candidates for long-term oral anticoagulation, namely patients with high risk of bleeding complications or previous hemorrhagic stroke. In those patients, percutaneous closure of left auricular appendage (LAA) has demonstrated to be safe and efficacious preventing cardioembolic events. However, some LAA are too large or too fragile and they may not be suitable for occlusion. We report a case of a videothoracoscopic LAA excision performed in an 82-years-old male with a previous intracerebral hemorrhagic event, showing the need to suppress oral anticoagulant therapy, and a two lobes LAA configuration which precluded percutaneous tight occlusion. Thoracoscopic appendectomy is potentially safe and may permit surgeons to remove the LAA relatively simply and completely. We believe this procedure should be considered as a possible alternative option to percutaneous closure of LAA in patients who are at great risk of thromboembolism and in whom anticoagulation is no longer tolerable.
