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Updated: Mar 7, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
[Closure of the left atrial appendage by means of the AtriClip System]
Insights
Epicardial left atrial appendage (LAA) occlusion with the AtriClip system offers a safe alternative to anticoagulation for stroke prevention in atrial fibrillation patients. This method effectively closes the LAA, reducing stroke risk without significant complications.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AFib) significantly increases stroke risk, primarily due to thrombi forming in the left atrial appendage (LAA).
- Current stroke prevention relies on anticoagulation, which carries inherent risks and limitations.
- Left atrial appendage occlusion (LAAO) presents an alternative strategy for stroke risk reduction in AFib patients.
Purpose of the Study:
- To evaluate the safety and efficacy of the epicardial AtriClip system for LAA occlusion.
- To assess the AtriClip system as a viable alternative to long-term anticoagulation for stroke prevention in AFib.
Main Methods:
- Performed LAA occlusion in 101 AFib patients (July 2012-September 2015) using the AtriClip system.
- Procedures included concomitant procedures (37), endoscopic MAZE plus clip (57), and stand-alone clip implantation (7).
- Implantation via sternotomy, minitoracotomy, or thoracoscopy; assessed via endoscopic ultrasound using Cleveland criteria.
Main Results:
- Achieved a 98% perioperative success rate for clip loading; no clip migration or endoleak observed.
- One periprocedural stroke occurred; during a mean follow-up of 18.5 months, 4 patients experienced TIA, with no strokes recorded.
- No thrombus detected at the appendage base post-procedure.
Conclusions:
- Epicardial LAA occlusion with the AtriClip system is a safe and reproducible method.
- This technique provides an important alternative for stroke prevention in patients with atrial fibrillation.
- The AtriClip system demonstrates favorable outcomes in reducing stroke risk associated with LAA thrombi.
Introduction:
Atrial fibrillation (AFib) is related to a high risk of stroke. The main role in etiopathogenesis is played by the left atrial appendage (LAA). As many as 95 % of thrombi in nonvalvular atrial fibrillation are located in the appendage. Prevention of stroke then consists in permanent anticoagulation which, however, has its limits and risks. An alternative method is the left atrial appendage occlusion. In our report, we would like to present a new possibility of the closure using the epicardial system AtriClip (AtriCure).
Methodology:
In the period beginning in July 2012 - September 2015 we performed LAA closure in 101 patients. A mean age of 65 ± 6 years, 47 women, CHA2DS2 VASc (Ø) 2.47 (0-6). Monitoring 1 837 (Ø 18.5) months. A concomitant procedure was performed in 37 patients, endoscopic MAZE plus clip in 57 patients, and 7 patients underwent stand-alone implantation of the clip. The clip was implanted from full sternotomy, minitoracotomy or through thoracoscopy. Clip loading, residual recess and endoleak were assessed through endoscopic ultrasound according to the Cleveland criteria.
Results:
The perioperative success rate of loading reached 98 %. The clip was loaded with a neck greater than 1 cm in 2 patients. No migration of the clip occurred, no endoleak was detected and no thrombus at the appendage base was detected. One case of periprocedural stroke was recorded. Within follow-up monitoring TIA occurred in 4 patients and no stroke was recorded.
Conclusion:
Epicardial LAA occlusion using the AtriClip system is a safe and reproducible method of LAA occlusion and an important alternative in the prevention of stroke.Key words: atrial fibrillation - occlusion of left atrial appendage - stroke.
