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Updated: Feb 19, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Outcome of left atrial appendage occlusion in high-risk patients
Ahmed Masoud1,2, Stefano Bartoletti1, Timothy Fairbairn1
1Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.
Insights
Left atrial appendage (LAA) occlusion offers an alternative to anticoagulation for stroke prevention in atrial fibrillation patients. While successful, the procedure has risks, and patients may still experience adverse events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Atrial fibrillation (AF) necessitates stroke prevention, often with oral anticoagulation.
- Oral anticoagulation poses bleeding risks, especially in elderly patients with high stroke risk scores.
- Left atrial appendage (LAA) occlusion presents an alternative interventional strategy.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous LAA occlusion using a standardized approach.
- To analyze patient characteristics, procedural outcomes, and 12-month follow-up data for LAA occlusion therapy.
Main Methods:
- A standardized protocol for patient referral, multidisciplinary assessment, and implant criteria was implemented.
- LAA occlusion was performed using the Amulet device.
- Patient data, procedural success rates, adverse events, and 12-month outcomes were analyzed.
Main Results:
- 83 high-risk patients (mean age 76, 32.5% female, CHAD2S2-VASc 4) with prior major bleeding were selected for LAA occlusion.
- Successful implantation (98.8%) was achieved with the Amulet device, despite 6.0% periprocedural adverse events (including 1 death).
- At 12 months, low rates of device-related thrombus (1.3%) and minor leaks (17.1%) were observed, alongside stroke and major bleeding events.
Conclusions:
- LAA occlusion is a viable option for stroke prevention in high-risk atrial fibrillation patients unsuitable for anticoagulation.
- The procedure has a high success rate but is associated with significant procedural complication risks.
- Patients remain at risk for adverse events and mortality post-implant, necessitating careful patient selection and monitoring.
Objective:
Percutaneous left atrial appendage (LAA) occlusion can be an interventional alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation.
Methods:
We delivered LAA occlusion therapy using a standardised approach to patient referral, multidisciplinary team assessment, implant criteria, imaging and follow-up. We analysed patient characteristics, efficacy and safety of the implant procedure, and 12-month outcomes.
Results:
Of 143 referrals from October 2014 to December 2016, 83 patients (age 76±8years, 32.5% female, mean CHAD2S2-VASc score 4 ±1) were offered LAA occlusion. Eighty (95.3%) had previous major bleeding (intracranial in 59%). LAA occluder implantation with an Amulet device was successful in 82 (98.8%), with periprocedural major adverse events occurring in 5 (6.0%) patients (2 device embolisations including 1 death, 2 major bleeds). Cardiac imaging in 75 (94%) patients 2months following implant showed device-related thrombus in 1 case (1.3%) and minor (<5mm) device leaks in 13 (17.1%). Over a median 12-month follow-up, 3 (3.8%) ischaemic strokes, 2 (2.5%) haemorrhagic strokes and 5 (6.3%) major extracranial bleeds occurred. All-cause mortality was 10%, with most deaths (7, 87.5%) due to non-cardiovascular causes.
Conclusions:
LAA occlusion may be a reasonable option for stroke prevention inhigh-risk patients with atrial fibrillation ineligible for anticoagulation. However, procedural complication rates are not insignificant, and patients remain at risk of serious adverse events and death even after successful implant.
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