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Updated: Mar 20, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
[Total Endoscopic Left Atrial Appendectomy for Valvular Atrial Fibrillation;Report of a Case]
Kanan Kurahashi1, Takafumi Inoue, Akihiro Yoshimoto
1Department of Cardiovascalar Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan.
Insights
Total endoscopic left atrial appendectomy offers a safe alternative for valvular atrial fibrillation (Af) patients at high risk of thromboembolism. This minimally invasive approach avoids cardiopulmonary bypass, proving effective in preventing stroke and other embolic events.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
- Minimally Invasive Procedures
Background:
- Valvular atrial fibrillation (Af) typically requires open-heart surgery.
- Cardiogenic thromboembolism is a significant risk in Af patients.
- Oral anticoagulant therapy is standard but carries bleeding risks.
Observation:
- A 67-year-old male with valvular Af and mitral stenosis experienced recurrent thromboembolism.
- Preoperative anticoagulation management led to cerebellar hemorrhage, canceling planned open-heart surgery.
- The patient presented a strong indication for an alternative thromboembolic prevention strategy.
Findings:
- Total endoscopic left atrial appendectomy was successfully performed without cardiopulmonary bypass.
- The minimally invasive procedure effectively addressed the risk of cardiogenic thromboembolism.
- The patient experienced an uneventful postoperative recovery.
Implications:
- Endoscopic left atrial appendectomy can be a viable option for selected valvular Af patients.
- This approach may reduce risks associated with cardiopulmonary bypass and anticoagulation.
- Further research could establish endoscopic appendectomy as a standard treatment for specific Af populations.
Abstract:
Total endoscopic left atrial appendectomy for non-valvular atrial fibrillation(Af) has been reported to be a safe and effective procedure to prevent cardiogenic thromboembolism and also discontinue oral anticoagulant therapy. On the other hand, open-heart surgery is generally indicated for valvular Af. We report the case of a 67-year-old male patient with valvular Af and recurrent episodes of cardiogenic thromboembolism who underwent total endoscopic left atrial appendectomy. He was diagnosed as having mitral valve stenosis and scheduled for surgery, but presented with cerebellar hemorrhage after warfarin was replaced with heparin in the preoperative phase. Consequently, the operation was cancelled. The case was considered as a good relative indication for total endoscopic left atrial appendectomy, which does not need a cardiopulmonary bypass, to prevent future cardiogenic thromboembolism. The operation was performed and the postoperative course was uneventful.
