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Updated: Mar 11, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Ablation of Atrial Fibrillation in Combination with Left Atrial Appendage Occlusion in A Single Procedure. Rationale
Ignacio García Bolao1, Naiara Calvo1, Alfonso Macias1
1Clinica Universidad de Navarra. Pamplona, Spain.
Insights
This review explores combining catheter ablation for atrial fibrillation (AF) with left atrial appendage occlusion (LAAO) to prevent stroke in high-risk patients unsuitable for blood thinners.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) increases stroke risk, with the left atrial appendage (LAA) often the source of clots.
- Oral anticoagulants (OACs) prevent thromboembolism but carry bleeding risks.
- Catheter ablation (CA) treats symptomatic AF, but its stroke prevention role is unproven.
Approach:
- This review examines the combined approach of AF catheter ablation (AFCA) and percutaneous LAA occlusion (LAAO).
- Focuses on patients with symptomatic, drug-refractory AF, high stroke risk, and OAC contraindications.
- Highlights shared procedural and technical aspects of these percutaneous interventions.
Key Points:
- Percutaneous LAA occlusion (LAAO) shows promise, demonstrating equivalence to OACs in reducing thromboembolic events.
- The combined AFCA and LAAO procedure aims to address both arrhythmia and stroke risk.
- Investigates the rationale, feasibility, outcomes, and technique of this combined interventional strategy.
Conclusions:
- The combined AFCA and LAAO procedure offers a potential solution for stroke prevention in specific AF patient populations.
- Further research is needed to solidify the role of combined interventions in AF management.
- This review provides insights into a novel approach for managing complex AF cases.
Abstract:
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and is associated with a fivefold increase in the risk of ischemic stroke and systemic embolism. Left atrial appendage (LAA) is the source of thrombi in up to 90% of patients with nonvalvular atrial fibrillation (AF). Although thromboembolic prophylaxis by means of oral anticoagulants (OAC) has been shown to be very effective (OAC), they also confer an inevitably risk of serious bleeding. Catheter ablation (CA) is an effective treatment for symptomatic AF but its role in stroke prevention remains unproved. Recently, LAA percutaneous occlusion has been demonstrated to be equivalent to OACs in reducing thromboembolic events. The aim of this review is to describe the rationale, feasibility, outcomes and technique of a combined procedure of AFCA and percutaneous LAAO, two percutaneous interventions that share some procedural issues and technical requirements, in patients with symptomatic drug-refractory AF, high risk of stroke, and contraindications to OACs.
