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Updated: Dec 1, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Device related thrombus after left atrial appendage closure: State of the art
Jiangtao Yu1, Yuan Bai2, Li-Sheng Jiang3
1Clinic for General Internal Medicine and Cardiology, Katholisches Klinikum Koblenz Montabaur, Koblenz, Germany.
Insights
Left atrial appendage closure (LAAC) offers an alternative to oral anticoagulation for stroke prevention in atrial fibrillation (AF). This review details device-related thrombus (DRT) risks and management following LAAC.
Area of Science:
- Cardiology
- Vascular Medicine
- Medical Devices
Background:
- Atrial fibrillation (AF) significantly increases stroke and embolism risk.
- The left atrial appendage (LAA) is a primary site for thrombus formation in AF patients.
- Oral anticoagulation (OAC) is standard but has bleeding and compliance issues.
Purpose of the Study:
- To provide a comprehensive review of device-related thrombus (DRT) after left atrial appendage closure (LAAC).
- To update knowledge on DRT incidence, mechanisms, risk factors, and management in nonvalvular AF (NVAF) patients.
Main Methods:
- Systematic literature review of studies on LAAC for stroke prevention in NVAF.
- Analysis of registered studies reporting on DRT post-LAAC.
- Synthesis of current evidence on DRT diagnosis and treatment.
Main Results:
- LAAC is non-inferior to OAC for stroke prevention in NVAF.
- Device-related thrombus (DRT) is a recognized complication of LAAC.
- DRT may be associated with an increased risk of stroke.
Conclusions:
- LAAC is an effective stroke prevention strategy in NVAF.
- Understanding and managing DRT is crucial for optimizing LAAC outcomes.
- Further research is needed to refine DRT prevention and treatment protocols.
Abstract:
Atrial fibrillation (AF), the most common arrhythmia, is a major cause of stroke and systemic embolism. Patients with AF are at higher risk of stroke with the left atrial appendage (LAA) being the most common site for thrombus formation. Although oral anticoagulation (OAC) remains the standard of care for stroke prevention in AF patients, there are still several limitations, including increased risk of bleeding and noncompliance. LAA closure (LAAC) has been found to be non-inferior to OAC in preventing all-cause strokes and systemic embolisms in randomized clinical trials, and is increasingly performed for stroke prevention in patients with nonvalvular AF (NVAF). However, device-related thrombus (DRT) after LAAC and a potentially increased risk of stroke related to DRT were observed in several registered studies, and attract wide concern. This review provides a comprehensive update on the incidence, mechanism, risk factors, prevention, diagnosis, and treatment of DRT after LAAC in patients with NVAF.
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