Percutaneous Left Atrial Appendage Closure Is a Reasonable Option for Patients With Atrial Fibrillation at High Risk for Cerebrovascular Events
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Updated: Feb 13, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Emmanuel Teiger1, Jean-Benoit Thambo1, Pascal Defaye1
1From the Interventional Cardiology Unit (E.T.) and Inserm, CIC 1430, U955 team 3 (P.L.C.), Henri Mondor Hospital, Creteil, France; Department of Pediatric and Congenital Cardiology, University Hospital of Bordeaux, Pessac, France (J.-B.T.); Department of Rhythmology, University Hospital of Grenoble-Alpes, France (P.D.); Department of Cardiac Arrhythmia, Picardie University Hospital, Amiens, France (J.-S.H.); Interventional Cardiology Unit, Hopital Prive du Confluent, Nantes, France (S.A.); Department of Electrophysiology, Lille University Hospital, France (D.K.); Département de cardiologie, Hôpital Bichat, DHU FIRE, INSERM U-1148, Université Paris Diderot, Sorbonne Paris-Cité, AP-HP, Paris (J.-M.J.); Montpellier University Hospital, CNRS UMR9214-Inserm U1046-PHYMEDEXP, Montpellier, France (J.-L.P.); Department of Interventional Cardiology, Cardiovascular Hospital of Lyon, Bron, France (G.R.); Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France (A.L.); Department of Cardiology, Rangueil Hospital, Toulouse, France (M.E.); Department of Cardiology, Paris South Cardiovascular Institute, Massy, France (J.H.); Department of Interventional Radiology, Marie-Lannelongue Hospital, Le Plessis-Robinson, France (P.B.); and Department of Cardiology, Hospital of Tours, France (B.P.).
Insights
Percutaneous left atrial appendage (LAA) closure effectively reduces stroke risk in high-risk atrial fibrillation patients. This registry confirms LAA closure is a viable option in complex patient populations.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Percutaneous left atrial appendage (LAA) closure is an emerging treatment for atrial fibrillation patients at high risk of stroke.
- The FLAAC registry (French Nationwide Observational LAA Closure Registry) was established to evaluate LAA closure in real-world clinical practice.
Purpose of the Study:
- To assess the outcomes of percutaneous LAA closure in a nationwide cohort of French patients.
- To evaluate the safety and efficacy of LAA closure in a high-risk population.
Main Methods:
- Prospective enrollment of 436 patients undergoing LAA closure across 33 French centers from April 2013 to September 2015.
- Data collection included patient demographics, comorbidities (CHA2DS2-VASc, HAS-BLED scores), devices used (Amplatzer, Watchman), procedural success, adverse events, and clinical outcomes at 1-year follow-up.
Main Results:
- High procedural success rate (98.4%) with a median follow-up of 12 months.
- Procedure-related severe adverse events occurred in 4.9% periprocedurally and 2.3% during follow-up.
- One-year cumulative incidences were 2.9% for ischemic stroke and 1.5% for cerebral hemorrhage; overall 1-year mortality was 9.3%.
Conclusions:
- LAA closure is primarily utilized in high-comorbidity, poor-prognosis patients in France.
- LAA closure appears to be a reasonable strategy for reducing stroke rates in this complex population.
- Preprocedural evaluation must consider the overall health status of patients undergoing LAA closure.
Background:
Percutaneous left atrial appendage (LAA) closure is an emerging option for patients with atrial fibrillation at high risk for cerebrovascular events. The multicenter FLAAC registry (French Nationwide Observational LAA Closure Registry) was established to assess LAA closure outcomes in everyday practice.
Methods And Results:
Four hundred thirty-six patients referred from April 2013 to September 2015 to 33 French interventional cardiology centers for percutaneous LAA closure were included prospectively in the FLAAC registry. Mean age was 75.4±0.4 years. The stroke risk was high (mean CHA2DS2-VASc score, 4.5±0.1) and most patients had experienced clinically significant bleeding (HAS-BLED score, 3.1±0.05). The device used was Amplatzer LAA occluder in 58% and the Watchman device in 42% of the patients. The procedural success rate was 98.4%. Median postprocedure follow-up was 12.0 (11.8-12.0) months and a single patient was lost to follow-up. During the periprocedural and subsequent follow-up period, procedure-related severe adverse events occurred in 21 (4.9%) and 10 (2.3%) patients, respectively. One-year cumulative incidences of ischemic stroke and cerebral hemorrhage were 2.9% (1.6-5.0) and 1.5% (0.7-3.2), respectively. Overall, 1-year mortality was 9.3% (6.9-12.5) with 7 of the 39 deaths related or possibly related to the device or procedure.
Conclusions:
This nationwide prospective registry shows that, in the French population, LAA closure is mainly used in patients with high comorbidity rates and a poor prognosis. LAA closure in such patients seems reasonable to decrease the stroke rate. The overall health status of these patients should be taken into account during the preprocedural evaluation process.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov. Unique identifier: NCT02252861.
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