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Updated: Dec 9, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Amplatzer left atrial appendage closure: Single versus combined procedures
Caroline Kleinecke1,2, Eric Buffle3, Juergen Link4
1Cardiology, Klinikum Lichtenfels, Lichtenfels, Germany.
Insights
Left atrial appendage closure (LAAC) with Amplatzer devices is safe and effective whether performed alone or combined with other cardiac interventions. Outcomes for single and combined procedures were comparable in this study.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Elderly patients frequently present with multiple cardiac conditions requiring simultaneous interventions.
- Optimizing patient outcomes necessitates efficient treatment strategies for complex cardiac conditions.
Purpose of the Study:
- To compare procedural and long-term clinical outcomes of left atrial appendage closure (LAAC) using Amplatzer devices.
- To evaluate LAAC as a standalone procedure versus a combined approach with other structural or coronary interventions.
Main Methods:
- A total of 559 patients underwent LAAC with Amplatzer devices across two Swiss university hospitals.
- Procedures were categorized as either single LAAC or combined with other interventions (e.g., PCI, PFO closure, TAVI).
- Primary endpoints included peri-procedural complications, major bleeding, stroke, systemic embolism, and cardiovascular death, assessed per 100 patient-years.
Main Results:
- Device success rates were high and comparable between single (96.6%) and combined (99.0%) procedures (p=0.08).
- After a mean follow-up of 2.5-2.6 years, primary efficacy endpoints (stroke, embolism, death) were similar (5.9% vs. 5.0%; HR 1.2).
- Primary safety endpoints (complications, bleeding) were also comparable between groups (3.7% vs. 3.8%; HR 1.0).
Conclusions:
- Left atrial appendage closure (LAAC) with Amplatzer devices is procedurally feasible and safe when combined with structural, coronary, or electrophysiological interventions.
- Combined LAAC procedures demonstrate comparable long-term safety and efficacy to standalone LAAC.
Objectives:
This study compares procedural and late clinical outcomes of left atrial appendage closure (LAAC) with Amplatzer devices as a single versus a combined procedure with other structural or coronary interventions.
Background:
Multiple cardiac conditions are frequent among elderly patients and invite simultaneous treatment to ensure a favorable patient outcomes.
Methods:
559 consecutive patients (73.3 ± 11.1 years) underwent LAAC with Amplatzer devices at two centres (Bern and Zurich university hospitals, Switzerland) either as a single procedure or combined with other interventions. The primary safety endpoint was a composite of major peri-procedural complications and major bleeding at follow-up, the primary efficacy endpoint included stroke, systemic embolism, and cardiovascular/unexplained death. All event rates are reported per 100 patient-years.
Results:
In 263 single and 296 combined procedures with percutaneous coronary interventions (47.6%), closure of an atrial septal defect (8.4%) or a patent foramen ovale (36.5%), transcatheter aortic valve implantation (10.1%), mitral clipping (4.1%), atrial fibrillation ablation (8.8%), or another procedure (3.0%) were analyzed. Device success (96.6% [single] vs. 99.0% [combined], p = .08) did not differ between the groups. After a mean follow-up of 2.6 ± 1.5 vs. 2.5 ± 1.5 years and a total of 1,422 patient-years, the primary efficacy (40/677, 5.9% [single] vs. 37/745, 5.0% [combined]; HR, 1.2, 95% CI, 0.8-1.9, p = .44), as well as the primary safety endpoint (25/677, 3.7% vs 28/745, 3.8%; HR, 1.0, 95% CI, 0.6-1.8, p = .89) were comparable.
Conclusions:
LAAC with Amplatzer devices combined with structural, coronary, and electrophysiological procedures offers procedural feasibility and safety, as well as long-term efficacy.
