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Updated: Dec 25, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage closure in patients with a reduced left ventricular ejection fraction: results from the
Christian Fastner1,2,3, Johannes Brachmann4, Thorsten Lewalter5
1First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Insights
Left atrial appendage closure (LAAC) is safe and effective for preventing strokes in atrial fibrillation patients, regardless of left ventricular ejection fraction (LVEF). Reduced LVEF did not impact procedural success or stroke prevention outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) patients are at high risk for thromboembolic events.
- Left atrial appendage closure (LAAC) is an effective strategy for stroke prevention in AF.
- Impaired left ventricular ejection fraction (LVEF) is associated with increased thromboembolic risk and procedural complications.
Purpose of the Study:
- To investigate the safety and efficacy of LAAC in patients with impaired LVEF.
- To assess the impact of LVEF on procedural success, complications, and long-term outcomes after LAAC.
Main Methods:
- Prospective, non-randomized registry (LAARGE) in Germany.
- Analysis of patients undergoing LAAC with different commercial devices.
- One-year follow-up with as-treated analysis based on documented LVEF.
Main Results:
- 619 patients categorized by LVEF: >55% (56%), 36-55% (36%), and ≤35% (8%).
- Cardiovascular comorbidity and CHA2DS2-VASc/HAS-BLED scores increased with LVEF reduction.
- High implantation success (>97.9%), low intra-hospital MACCE (0.5%), and complication rates (4.2%) across all LVEF groups.
Conclusions:
- Reduced LVEF did not affect procedural success, effectiveness, or safety of LAAC for stroke prevention.
- LAAC is a viable option for AF patients with impaired LVEF.
- Outcomes suggest LAAC is safe and effective across the LVEF spectrum.
Background:
Interventional left atrial appendage closure (LAAC) effectively prevents thromboembolic events in atrial fibrillation patients. Impaired left ventricular ejection fraction (LVEF) increases not only the thromboembolic risk but also the complication rates of cardiac interventions. The LAAC procedure's benefit in patients with an impaired LVEF, therefore, has yet to be investigated.
Methods:
LAARGE is a prospective, non-randomized registry depicting the clinical reality of LAAC in Germany. Procedure was conducted with different standard commercial devices, and follow-up period was one year. In the sense of an as-treated analysis, patients with started procedure and documented LVEF were selected from the whole database.
Results:
619 patients from 37 centers were categorized into one of three groups: LVEF > 55% (56%), 36-55% (36%), and ≤ 35% (8%). Prevalence of cardiovascular comorbidity increased with LVEF reduction (p < 0.001 for trend). CHA2DS2-VASc score was 4.3, 4.8, and 5.1 (p < 0.001), and HAS-BLED score was 3.7, 4.1, and 4.2 (p < 0.001). Implantation success was consistently high (97.9%), rates of intra-hospital MACCE (0.5%), and other major complications (4.2%) were low (each p = NS). Kaplan-Meier estimation showed a decrease in survival free of stroke with LVEF reduction during one-year follow-up (89.3 vs. 87.0 vs. 79.8%; p = 0.067), a trend which was no longer evident after adjustment for relevant confounding factors. Rates of non-fatal strokes (0.4 vs. 1.1 vs. 0%) and severe bleedings (0.7 vs. 0.0 vs. 3.1%) were consistently low across all groups (each p = NS).
Conclusions:
LVEF reduction neither influenced the procedural success nor the effectiveness and safety of stroke prevention by LAAC.
Trial Registration:
ClinicalTrials.gov Identifier: NCT02230748.
