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Updated: Mar 16, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage occlusion in high-risk patients with non-valvular atrial fibrillation
Sergio Berti1, Luigi Emilio Pastormerlo1,2, Marco Rezzaghi1
1Fondazione Toscana G. Monasterio-Ospedale del Cuore G. Pasquinucci, Massa, Italy.
Insights
Left atrial appendage (LAA) occlusion is a safe and effective stroke prevention method for non-valvular atrial fibrillation (NVAF) patients unsuitable for anticoagulants, showing low complication and event rates in long-term follow-up.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Percutaneous left atrial appendage (LAA) occlusion is an alternative for stroke prevention in non-valvular atrial fibrillation (NVAF) patients at high risk for cardioembolic events.
- Limited data exist on device implantation and long-term outcomes in large patient cohorts.
Purpose of the Study:
- To evaluate the feasibility and long-term safety and efficacy of LAA occlusion in NVAF patients with contraindications to oral anticoagulants (OACs).
Main Methods:
- A prospective registry of 110 consecutive NVAF patients who underwent LAA occlusion (Amplatzer Cardiac Plug or Amulet) was analyzed.
- Procedures were guided by fluoroscopy and intracardiac echocardiography, with follow-up exceeding one year.
Main Results:
- Technical and procedural success rates were 100% and 96.4%, respectively, with a 3.6% rate of major procedural complications.
- Mean follow-up was 30 months. Annual rates for ischemic stroke, other thromboembolic events, and major bleeding were 2.2%, 0%, and 1.1%, respectively.
Conclusions:
- LAA occlusion is a feasible and safe option for stroke prevention in high-risk NVAF patients unsuitable for OACs.
- The procedure is associated with low complication rates and favorable long-term outcomes regarding stroke and bleeding events.
Objective:
Percutaneous left atrial appendage (LAA) occlusion has been developed as a viable option for stroke and thromboembolism prevention in patients with non-valvular atrial fibrillation (NVAF) and at high risk for cerebral cardioembolic events. Data on device implantation and long-term follow-up from large cohorts are limited.
Methods:
110 consecutive patients with NVAF and contraindications to oral anticoagulants (OACs) underwent LAA occlusion procedures and achieved a longer than 1 year follow-up. All patients were enrolled in a prospective registry. Procedures were performed using the Amplatzer Cardiac Plug or Amulet guided by fluoroscopy and intracardiac echocardiography.
Results:
Mean age of the population was 77±6 years old; 68 were men. Atrial fibrillation was paroxysmal in 20%, persistent in 15.5% and permanent in 64.5% of cases, respectively. Mean CHA2DS2-VASc and HAS-BLED scores were 4.3±1.3 and 3.4±1, respectively. Technical success (successful deployment and implantation of device) was achieved in 100% of procedures. Procedural success (technical success without major procedure-related complications) was achieved in 96.4%, with a 3.6% rate of major procedural complications (three cases of pericardial tamponade requiring drainage and one case of major bleeding). Mean follow-up was 30±12 months (264 patient-years). Annual rates for ischaemic stroke and for other thromboembolic events were respectively 2.2% and 0%, and annual rate for major bleeding was 1.1%.
Conclusions:
Our data suggest LAA occlusion in high-risk patients with NVAF not suitable for OACs is feasible and associated with low complication rates as well as low rates of stroke and major bleeding at long-term follow-up.
