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Updated: Dec 8, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Why should cardiac surgeons occlude the left atrial appendage percutaneously?
Radoslaw Litwinowicz1,2, Piotr Mazur1,2, Marian Burysz3
1Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland.
Insights
Cardiac surgeons can safely perform percutaneous left atrial appendage occlusion (LAAO) procedures. This study shows LAAO by surgeons is safe and effective, with excellent outcomes for patients with atrial fibrillation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Percutaneous left atrial appendage occlusion (LAAO) is typically performed by cardiologists.
- This study investigates the feasibility and outcomes of LAAO performed exclusively by cardiac surgeons.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous LAAO when performed solely by cardiac surgeons.
- To compare outcomes of LAAO performed by surgeons versus predicted risks.
Main Methods:
- A total of 223 patients with nonvalvular atrial fibrillation underwent percutaneous LAAO at two cardiac surgery centers.
- Procedures utilized either endocardial occluders (Amulet, LAmbre) or the epicardial LARIAT device.
- Data collected included procedural success, adverse events, and long-term follow-up.
Main Results:
- The procedure demonstrated a high success rate of 97.3%.
- Procedural or device-related adverse events occurred in 4.4% of cases.
- Long-term follow-up showed a 71% reduction in thromboembolism and a 69% reduction in bleeding compared to predicted risks.
Conclusions:
- Percutaneous LAAO can be safely and effectively performed by cardiac surgeons without cardiological assistance.
- Both endocardial and epicardial LAAO techniques are feasible for cardiac surgeons.
- Training cardiac surgeons in LAAO procedures is recommended.
Objectives:
Percutaneous left atrial appendage (LAA) occlusion (LAAO) is a procedure dominated by cardiologists. The aim of our study was to present the results of percutaneous LAAO performed solely by cardiac surgeons.
Methods:
Two hundred twenty-three consecutive patients with nonvalvular atrial fibrillation underwent percutaneous LAAO in two cardiac surgery sites. In the first center, all 84 LAAO procedures were performed with the endocardial LAA occluders: 60 cases with the Amulet and 24 cases with the LAmbre. In the second center, all 139 LAAO procedures were performed with the LARIAT epicardial device.
Results:
The mean CHA2 DS2 -VASc-score was 3.7 ± 1.8 points, and mean HAS-BLED score was 3.6 ± 1.2 points. The procedure was successful in 97.3% of cases. Procedural or device-related adverse events were noted in 4.4% (n = 10) of cases: one periprocedural cardiac arrest, one aortic injury, one gastrointestinal bleeding, three cases of vascular access complications, and four cardiac tamponades. After a follow-up of 40.3 ± 17.3 months, 78.4% of patients were alive, with the annual mortality rate of 5.3%. Compared to the predicted risk, the observed incidence of thromboembolism was lower by 71%, and the bleeding incidence was lower by 69%.
Conclusions:
Percutaneous LAAO procedures can be safely performed by cardiac surgeons, with no cardiological assistance. LAAO done by surgeons is safe and effective, and periprocedural and long-term outcomes are excellent. Cardiac surgeons should be trained in both types of LAAO: endocardial and epicardial.
