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Related Experiment Video

Updated: Dec 6, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Stand-Alone Thoracoscopic Left Atrial Appendage Closure in Nonvalvular Atrial Fibrillation Patients at High Bleeding

Marco Franciulli1, Giuseppe De Martino2, Mariateresa Librera3

  • 147235 Department of Cardiac Surgery, Mediterranea Cardiocentro, Naples, Italy.

Innovations (Philadelphia, Pa.)
|October 13, 2020
PubMed
Summary

Thoracoscopic left atrial appendage closure offers a safe alternative for high-risk atrial fibrillation patients, eliminating the need for post-procedure anticoagulation or antiplatelet therapy.

Keywords:
AtriClipatrial fibrillationhigh bleeding riskleft atrial appendagethoracoscopy

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Area of Science:

  • Cardiology
  • Minimally Invasive Surgery
  • Thrombosis Management

Background:

  • Nonvalvular atrial fibrillation (AF) patients at high bleeding risk often face contraindications for oral anticoagulants (OAC).
  • Percutaneous left atrial appendage (LAA) closure is an option, but requires subsequent OAC or dual antiplatelet therapy.
  • This poses a challenge for patients with absolute contraindications to antithrombotic treatment.

Purpose of the Study:

  • To evaluate the efficacy and safety of thoracoscopic LAA closure as a standalone procedure.
  • To assess outcomes in nonvalvular AF patients at high bleeding risk who cannot tolerate antithrombotic therapy.
  • To determine if this technique avoids the need for postoperative OAC or dual antiplatelet treatment.

Main Methods:

  • Twenty consecutive nonvalvular AF patients with high bleeding risk (mean HAS-BLED score 4.42) underwent thoracoscopic LAA closure using an epicardial clip device.
  • The procedure was performed as a stand-alone intervention, with no subsequent OAC or antiplatelet therapy.
  • Transesophageal echocardiography assessed complete LAA closure. Endpoints included closure success, operative complications, mortality, and 30-day/6-month adverse events.

Main Results:

  • Complete LAA closure was achieved in all 20 patients.
  • There were no operative complications or deaths related to the clip device.
  • Follow-up demonstrated 95% freedom from postoperative complications and 100% freedom from cerebrovascular events, with an overall survival rate of 100%.

Conclusions:

  • Thoracoscopic LAA closure is a viable alternative for nonvalvular AF patients at high bleeding risk (HAS-BLED >3).
  • This technique effectively precludes the need for post-procedural antithrombotic therapy.
  • External LAA clipping may reduce the risk of thromboembolic events compared to percutaneous methods.