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Updated: Mar 31, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage occlusion in atrial fibrillation for stroke prevention: A systemic review
Xianhui Zhou1, Wenhui Zhang1, Wenkui Lv1
1Pacing and Electrophysiological Division, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
Insights
Left atrial occlusion (LAAO) shows comparable efficacy to warfarin for stroke prevention in atrial fibrillation (AF). Both percutaneous and surgical LAAO approaches are supported, offering a potential alternative for AF patients.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Trials
Background:
- Atrial fibrillation (AF) increases stroke risk, with thrombi often forming in the left atrial appendage (LAA).
- Left atrial occlusion (LAAO) is explored as a stroke prevention strategy in AF patients.
Purpose of the Study:
- To evaluate the efficacy and safety of LAAO for preventing stroke in individuals with AF.
Main Methods:
- A meta-analysis of three randomized controlled trials (1165 participants) was conducted.
- Included studies assessed percutaneous and surgical LAAO compared to warfarin.
- Study quality was assessed, and data analyzed using RevMan 5.3.
Main Results:
- Left atrial occlusion (LAAO) demonstrated similar efficacy to warfarin in preventing stroke (RR 0.78 [0.33, 1.84]).
- LAAO also suggested a trend towards reduced mortality (RR 0.68 [0.40, 1.16]).
- Percutaneous LAAO (1114 participants) and surgical LAAO (51 participants) were analyzed.
Conclusions:
- Left atrial occlusion, particularly with the Watchman device, appears as effective as warfarin for stroke reduction in AF.
- Surgical LAAO shows promise but requires further investigation due to smaller sample sizes.
- Both percutaneous and surgical LAAO methods support this therapeutic approach.
Background:
Atrial fibrillation (AF) is an arrthymia characterized by increased risk of ventricle arrthymias and thromboembolism especially ischemic stroke. Most thrombus originated in the left atrial appendage, thus left atrial occlusion (LAAO) may be an effective alternative for stroke prevention in atrial fibrillation.
Objective:
To assess the effect and safety of left atrial occlusion for stroke prevention in atrial fibrillation.
Methods And Results:
We searched Pub Med, CENTRAL in The Cochrane Library, Embase, CBM-Disk, CNKI for published trials, ClinicalTrials.gov, ISI Proceedings for conference abstracts, and WHO International Clinical Trial registration Platform for ongoing studies. The search results were extracted, and then the quality of included studies was assessed. By RevMan 5.3, meta analysis was used if there was low heterogeneity. Three randomized controlled clinical trials involving 1165 participants were included (percutaneous 1114 in 2 trials, surgical 51 in 1 trial). The current data suggest that left atrial occlusion may be as efficacious as warfarin in stroke prevention (RR 0.78 [0.33, 1.84]) and mortality reduction (RR 0.68 [0.40, 1.16]) for AF.
Conclusion:
In contrast to warfarin left atrial occlusion with Watchman device may have the same effectivity in stroke reduction. Surgical LAAO may also get positive outcomes compared with warfarin, but owing to the small sample size the evidence is less powerful. Total outcomes of percutaneous and surgical LAAO support this approach.
