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Updated: Feb 18, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
[Left atrial appendage clusure in nonvalvular atrial fibrillation : Clinical evidence 2017]
Steffen Gloekler1, Bajram Hajredini2, Simon Rycerz2
1Klinik für Innere Medizin III, Kardiologie, Schwarzwald-Baar-Klinikum, 78052, Villingen-Schwenningen, Deutschland. steffen.gloekler@sbk-vs.de.
Insights
Left atrial appendage closure (LAAC) offers a promising alternative to lifelong oral anticoagulation for preventing stroke in patients with nonvalvular atrial fibrillation (AF). Recent trials show LAAC is effective and safe, potentially reducing risks associated with long-term anticoagulation.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Thrombosis and Hemostasis
Background:
- Nonvalvular atrial fibrillation (AF) is a common arrhythmia increasing stroke risk.
- Thrombi typically form in the left atrial appendage (LAA), a key source of embolism.
- Oral anticoagulation (OAC) with VKAs and NOACs is standard but carries bleeding risks.
Purpose of the Study:
- To review the current evidence on left atrial appendage closure (LAAC) for stroke prevention in nonvalvular AF.
- To compare LAAC efficacy and safety against traditional oral anticoagulation.
- To discuss LAAC devices, techniques, and clinical outcomes.
Main Methods:
- Review of prospective randomized trials comparing LAAC to VKA.
- Analysis of clinical evidence on the efficacy and safety of LAAC.
- Elucidation of the limitations of current anticoagulation strategies.
Main Results:
- LAAC demonstrated superior efficacy compared to VKA in mid-term results.
- LAAC showed noninferior safety outcomes compared to VKA.
- LAAC presents a viable alternative to indefinite OAC, mitigating associated risks.
Conclusions:
- Left atrial appendage closure is an effective and safe alternative for stroke prevention in nonvalvular AF patients.
- LAAC offers a potential solution to the safety concerns of long-term oral anticoagulation.
- Further evidence supports LAAC as a key strategy in managing AF-related thromboembolic risk.
Abstract:
Nonvalvular atrial fibrillation (AF) is the most common arrhythmia with a prevalence of 1-2% and affects approximately 15-20% of all octogenarians. Patients are at increased risk of thromboembolic stroke, with an overall risk of 5% per year. Thrombi form almost exclusively in the left atrial appendage (LAA), a blind sac-like heterogeneous structure trabeculated by pectinate muscles. In the past five decades, life-long oral anticoagulation (OAC) with vitamin K antagonists (VKA) has been the state-of-the art treatment to prevent stroke and systemic embolism from thrombi in AF. In the last decade, nonvitamin K dependent oral anticoagulants (NOAC) have been shown to be superior to VKA. Given the safety issues of indefinite OAC with either VKA or NOAC, it is plausible to consider left atrial appendage closure (LAAC) as an alternative strategy to prevent death, stroke or other systemic embolization, and bleeding. In recent years, LAAC has been compared to VKA in prospective randomized trials, yielding superior results regarding efficacy and noninferiority regarding safety in the mid-term. This review provides an update on the current state of LAAC in the field of prevention of death, stroke, and bleedings in patients suffering from nonvalvular AF. We elucidate the evidence and limitations of anticoagulation as the classical treatment paradigm, and review devices and techniques for LAAC. Most importantly, the current clinical evidence on efficacy and safety is outlined.
