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Updated: Feb 10, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

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Thoracoscopic stapler-and-loop technique for left atrial appendage closure in nonvalvular atrial fibrillation:

Toshiya Ohtsuka1, Takahiro Nonaka1, Motoyuki Hisagi1

  • 1Department of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.

Heart Rhythm
|May 28, 2018
PubMed

Insights

Left atrial appendage (LAA) closure using a thoracoscopic stapler-and-loop technique is a safe and effective alternative to anticoagulation for preventing stroke in nonvalvular atrial fibrillation patients. This method achieved complete closure and acceptable mid-term prevention of cardiogenic thromboembolisms.

Area of Science:

  • Cardiology
  • Minimally Invasive Surgery

Background:

  • Left atrial appendage (LAA) closure offers an alternative to oral anticoagulation for preventing cardiogenic thromboembolisms in patients with nonvalvular atrial fibrillation.
  • The study focuses on evaluating a specific thoracoscopic technique for LAA closure.

Purpose of the Study:

  • To retrospectively evaluate the safety, completeness, and mid-term prevention of a thoracoscopic stapler-and-loop technique for LAA closure.
  • Assess the efficacy of LAA closure as an alternative to long-term anticoagulation.

Main Methods:

  • Review of 201 patients operated on between October 2008 and February 2017 using endoscopic stapler and ligation loops.
  • Primary endpoints included hospital death and major procedure-related complications; secondary endpoint was prevention of cardiogenic thromboembolisms.
  • Brain MRI was used to investigate new thromboembolic spots one year post-surgery.

Main Results:

  • A total of 201 patients (mean age 74 years, high CHA₂DS₂-VASc and HAS-BLED scores) underwent the procedure with a mean operation time of 28 minutes.
  • All LAAs were completely closed, confirmed by intraoperative transesophageal echocardiography, with no hospital deaths or major complications.
  • Mid-term follow-up (mean 48 months) in 198 patients showed 2 cases of cardiogenic thromboembolisms (0.25 events/100 patient-years); MRI revealed new spots in 3.9% of patients.

Conclusions:

  • The thoracoscopic stapler-and-loop technique provides swift, safe, and complete LAA closure in patients with nonvalvular atrial fibrillation.
  • This method offers acceptable mid-term prevention of thromboembolic events without the need for anticoagulation.
Abstract

Keywords:
Cardiogenic thromboembolismLeft atrial appendageNonvalvular atrial fibrillationStaplerThoracoscopic surgery

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