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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
Left atrial appendage occlusion in recurrent ischaemic stroke, a multicentre experience
X Galloo1,2, T Carmeliet1,2, E A Prihadi1
1Cardiology Department, ZNA Hartcentrum - ZNA Middelheim, Antwerp, Belgium.
Insights
Left atrial appendage occlusion (LAAO) is a feasible and safe adjunctive therapy for non-valvular atrial fibrillation (NVAF) patients experiencing recurrent strokes despite oral anticoagulation therapy (OAC). This procedure shows promise in reducing further ischemic events in high-risk individuals.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Stroke Prevention
Background:
- Oral anticoagulation therapy (OAC) is standard for preventing ischemic stroke in non-valvular atrial fibrillation (NVAF) patients.
- Percutaneous left atrial appendage occlusion (LAAO) is an alternative for patients intolerant to OAC.
- Recurrent stroke on OAC is considered treatment failure, suggesting LAAO as a potential option based on expert opinion.
Purpose of the Study:
- To evaluate the efficacy, safety, and mortality of LAAO in NVAF patients with recurrent ischemic stroke.
- To assess LAAO outcomes after excluding other potential causes of recurrent stroke.
Main Methods:
- A multicenter retrospective cohort study.
- Inclusion of NVAF patients who experienced recurrent ischemic stroke despite ongoing OAC.
- Exclusion of other plausible causes for recurrent stroke.
Main Results:
- Fifteen LAAO procedures were performed in high-risk NVAF patients (mean CHA2DS2-VASc score 6, HAS-BLED score 5).
- Successful LAAO implantation was achieved in all patients (Amplatzer and Watchman devices), with high feasibility and low complication rates.
- Low rates of recurrent stroke (two ischemic, zero hemorrhagic) and mortality were observed during follow-up, with OAC continued long-term in most patients.
Conclusions:
- LAAO can be considered a feasible and safe adjunctive therapy, not a replacement, for NVAF patients with recurrent stroke despite adequate OAC.
- The findings support LAAO as a valuable option for stroke risk reduction in this specific high-risk patient population.
Background:
Oral anticoagulation therapy (OAC) remains the gold standard for ischaemic stroke prevention in patients with non-valvular atrial fibrillation (NVAF) and elevated stroke risk. Percutaneous left atrial appendage occlusion (LAAO) has emerged as a potential alternative for stroke prevention in patients who cannot tolerate OAC. Although no randomized data is available, recurrent stroke in NVAF-patients, while on adequate OAC, is regarded as a treatment failure and therefore is considered as a potential indication for LAAO, based upon expert opinion.
Methods/Objectives:
A multicentre retrospective cohort study evaluating efficacy, safety and mortality of LAAO in NVAF-patients presenting with recurrent ischaemic stroke, after excluding other plausible causes.
Results:
Fifteen LAAO have been performed in NVAF-patients with recurrent stroke despite ongoing OAC, after exclusion of other plausible causes. Mean age was 78.1 ± 5.8 years, mean CHA2DS2-VASc-score = 6 ± 1.2 and mean HAS-BLED-score = 5 ± 1.2. Successful implantation was achieved in all patients (73% Amplatzer device and 27% Watchman device), without any access-related complications and only one procedure/device-related complication (device embolization) was reported. In all but four patients, OAC was continued at long term after LAAO. No haemorrhagic strokes and only two ischaemic strokes were observed. During follow-up three patients died, all due to non-atrial fibrillation or non-device-related causes.
Conclusions:
In NVAF-patients at high risk for stroke presenting with recurrent stroke despite adequate OAC, LAAO may be considered an adjunctive, but not alternative treatment to OAC with high feasibility and safety.
Abstract:
Abbreviations: AF: atrial fibrillation; ESC: European Society of Cardiology; INR: international normalized ratio; LAA: left atrial appendage; LAAO: left atrial appendage occlusion; NOAC: non-vitamin K oral anticoagulants; NVAF: non-valvular atrial fibrillation; OAC: oral anticoagulation; RS: recurrent (ischaemic) stroke; SD: standard deviation; TIA: transient ischaemic attack; TOE: transoesophageal echocardiography; TTE: transthoracic echocardiography; VKA: vitamin K antagonists.
