Related Experiment Video
Updated: Mar 3, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Occlusion for Stroke Prevention
Arijit Chanda1, John P Reilly1
1John Ochsner Heart & Vascular Center, Cardiac Catheterization Laboratory, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA 70121.
Insights
Atrial fibrillation (AF) patients at high stroke risk can opt for left atrial appendage (LAA) exclusion instead of anticoagulation. Several devices offer percutaneous LAA closure, minimizing stroke risk for those unsuitable for blood thinners.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Procedures
Background:
- Over 2.3 million US adults have atrial fibrillation (AF), significantly increasing stroke risk.
- The left atrial appendage (LAA) is the primary source of thrombus in AF patients.
- Anticoagulation is standard for stroke prevention but contraindicated in some patients.
Purpose of the Study:
- To review percutaneous left atrial appendage (LAA) exclusion as an alternative to anticoagulation for stroke risk reduction in AF patients.
- To discuss available LAA exclusion devices and their applications.
Main Methods:
- Review of current percutaneous left atrial appendage (LAA) exclusion devices available in the US.
- Discussion of the WATCHMAN®, Amulet®, and LARIAT® systems.
- Consideration of procedural complications and operator experience.
Main Results:
- Percutaneous LAA exclusion is a viable alternative for AF patients with contraindications to anticoagulation.
- The WATCHMAN® device is FDA-approved and widely studied for LAA exclusion.
- The Amulet® device is under investigation in a trial comparing it to WATCHMAN®, and the LARIAT® is a hybrid system.
Conclusions:
- Percutaneous LAA closure offers a stroke risk reduction strategy for specific AF patient populations.
- Operator experience is crucial for minimizing procedural complications associated with LAA exclusion.
- Continued research and device development aim to improve safety and efficacy.
Abstract:
More than 2.3 million adults in the United States have atrial fibrillation (AF), which exposes them to a 5-fold increased risk of stroke. The left atrial appendage (LAA) appears to be the source of thrombus formation in the vast majority of these patients. Anticoagulation significantly reduces the risk of stroke, but often we encounter patients who have absolute or relative contraindication to anticoagulation. Percutaneous LAA exclusion offers an alternative to anticoagulation to decrease the risk of stroke. Three device systems are currently available in the United States. The WATCHMAN® device is the most studied and approved by Food and Drug Administration (FDA) to be used in patients with AF unsuitable for anticoagulation who are at a high risk of stroke. The Amulet® device is currently being used as part of the AMPLATZER® Amulet® LAA Occluder trial, which is a non-inferiority randomized trial comparing the Amulet® to the WATCHMAN® device. The third device in use is the LARIAT®, which is an FDA approved snare and pre-tied stich system. It is used to approximate soft tissue which in this case is the LAA. It is a hybrid system and requires both epicardial and endocardial access. The main obstacle to percutaneous LAA closure is procedural related complications, which can be minimized with optimum operator experience.
