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Updated: Feb 16, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
The Left Atrial Appendage Revised
Paulo Roberto Barbosa Evora1, Antonio Carlos Menardi1, Andrea Carla Celotto1
1Division of Cardiovascular and Thoracic Surgery, Department of Surgery and Anatomy of the Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), SP, Brazil.
Insights
Nonvalvular atrial fibrillation increases stroke risk, often linked to left atrial appendage thrombus. This review emphasizes anatomical and pharmacological factors for surgical left atrial appendage exclusion, a key stroke prevention strategy.
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Education
Background:
- Nonvalvular atrial fibrillation (NVAF) significantly elevates stroke risk (4-5 fold increase), accounting for 15-20% of elderly strokes.
- Left atrial appendage (LAA) thrombus is implicated in 90% of these stroke cases.
- Current management strategies including anticoagulants, percutaneous devices, and surgical LAA exclusion remain subjects of ongoing discussion.
Purpose of the Study:
- To provide a review focused on basic aspects of LAA exclusion for continuous medical education.
- To emphasize the anatomical and pharmacological considerations for simple surgical exclusion of the LAA under cardiopulmonary bypass.
Main Methods:
- Review of existing literature on LAA anatomy, physiology, and surgical exclusion techniques.
- Discussion of pharmacological aspects relevant to LAA procedures.
- Presentation of a specific surgical technique for LAA exclusion based on fundamental scientific principles.
Main Results:
- LAA exclusion during cardiac surgery may increase early postoperative atrial fibrillation risk.
- Understanding relevant anatomical spatial relationships is crucial for LAA procedures.
- Physiological functioning of the LAA may be eliminated by exclusion procedures.
Conclusions:
- Surgical exclusion of the LAA is a relevant strategy for stroke prevention in NVAF.
- A thorough understanding of anatomical and pharmacological principles is essential for safe and effective LAA exclusion.
- The review aims to equip medical professionals with foundational knowledge for LAA procedures, presenting a specific technique as an example.
Abstract:
Nonvalvular atrial fibrillation is associated with a 4- to 5-fold strokes increase and may be responsible for 15% to 20% of all strokes in the elderly. In this scenario, the left atrial appendage thrombus would be the associated with 90% of cases. The use of anticoagulants, percutaneous devices, and the left atrial appendage surgical exclusion is still an open discussion. For left atrial appendage procedures, relevant anatomic spatial relationships have to be emphasized, besides the chance of the normal physiological functioning would be eliminated with the proceedings. There are evidences that the left atrial appendage closure during routine cardiac surgery is significantly associated with an increased risk of early postoperative atrial fibrillation. Therefore, the purpose of this review is to focus basic aspects for continuous medical education. In summary, the rationale of this text is to emphasize anatomical and pharmacological aspects involved in the simple surgical exclusion of left atrial appendage under cardiopulmonary bypass. There are several operative techniques, but to conclude this revision it will present one of them based on the discussed basic sciences.
