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Updated: Aug 18, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Percutaneous Left Atrial Appendage Closure: is there a Role in Valvular Atrial Fibrillation
Chetan Huded1, Amar Krishnaswamy1, Samir Kapadia1
1Department of Cardiovascular Medicine, Cleveland Clinic Foundation (Cleveland, OH).
Insights
Valvular atrial fibrillation (AF) lacks a clear definition, complicating stroke risk management. Current treatments exclude many patients, highlighting the need for trials on left atrial appendage occlusion in this population.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Trials
Background:
- Atrial fibrillation (AF) affects over 33 million globally, categorized by valvular vs. non-valvular etiology.
- Definitions of valvular AF vary, lacking consensus and historically excluding patients from trials.
- Rheumatic mitral valve disease with AF poses high cardioembolic stroke risk, with limited treatment options beyond vitamin K antagonists.
Purpose of the Study:
- To address the lack of consensus on valvular AF definitions and stroke risk management.
- To explore the potential role of percutaneous left atrial appendage occlusion in valvular AF.
- To identify knowledge gaps for future clinical trials in valvular AF management.
Main Methods:
- Review of current literature on valvular AF definitions and treatment strategies.
- Analysis of existing trial data and exclusion criteria regarding valvular heart disease.
- Identification of unmet needs in anticoagulation and device therapy for valvular AF.
Main Results:
- No clear consensus definition for valvular AF exists.
- Vitamin K antagonists are the primary stroke risk mitigation strategy.
- The efficacy of left atrial appendage occlusion in valvular AF remains uncertain.
Conclusions:
- The definition and management of valvular AF require clarification.
- Percutaneous left atrial appendage occlusion is a potential future therapy for valvular AF.
- Further clinical trials are crucial to guide treatment for millions with valvular AF.
Abstract:
Atrial fibrillation, a chronic and highly morbid cardiovascular condition which affects over 33 million people worldwide, can be broadly categorized as valvular vs non-valvular in etiology. However, definitions of valvular atrial fibrillation have varied widely in the literature, and there is no clear consensus definition to date. Historically, patients with atrial fibrillation in the setting of rheumatic mitral valve disease have constituted a particularly high risk group for cardioembolic stroke, and for this reason many contemporary trials of pharmaceutical and device therapies for atrial fibrillation have systematically excluded patients with valvular heart disease. Therefore, vitamin K antagonism remains the favored approach to mitigate stroke risk in valvular atrial fibrillation, and the optimal strategy to treat atrial fibrillation patients with valvular heart disease who cannot tolerate oral anticoagulation therapy is unknown. Recent trials have demonstrated an important role for percutaneous left atrial appendage occlusion devices in patients with non-valvular atrial fibrillation, but the role of these devices in patients with valvular atrial fibrillation is uncertain. Given the worldwide burden of valvular atrial fibrillation, future trials intended to clarify the role of percutaneous left atrial appendage closure devices in valvular atrial fibrillation should provide important insight for the care of millions of patients.
