Related Experiment Video
Updated: Nov 28, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage occlusion in atrial fibrillation patients with previous intracranial bleeding: A national
Gavino Casu1, Giuseppe D'Angelo2, Fabrizio Ugo3
1Department of Cardiology, San Francesco Hospital, ATS Sardegna, Nuoro, Italy; Ph.D Course, University of Sassari, Sassari, Italy.
Insights
Left atrial appendage (LAA) occlusion effectively treats atrial fibrillation (AF) patients with prior intracranial hemorrhage (ICH). This procedure offers a safe alternative to oral anticoagulation, reducing stroke and bleeding risks.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Intracranial hemorrhage (ICH) is a severe complication of oral anticoagulant therapy (OAT) in atrial fibrillation (AF) patients.
- Managing AF patients with a history of ICH poses significant clinical challenges.
- Left atrial appendage (LAA) occlusion presents an alternative for OAT-intolerant AF patients, but long-term data are limited.
Purpose of the Study:
- To evaluate the safety and efficacy of LAA occlusion in AF patients with a history of ICH.
- To assess procedural outcomes and 12-month follow-up data for LAA occlusion in this high-risk population.
Main Methods:
- A multicenter, observational, retrospective study involving 120 consecutive patients with nonvalvular AF and prior ICH.
- Analysis of procedural success, peri-procedural complications, post-procedural therapies, and 12-month clinical outcomes.
- Comparison of observed stroke and bleeding rates against expected annual risks.
Main Results:
- Successful LAA occlusion was achieved in 100% of patients, with a 6% major peri-procedural complication rate.
- The study population had high annual risks for stroke (5.18%) and bleeding (6.62%).
- Observed annual stroke rate was 1.8% (excluding peri-procedural events), and the observed annual bleeding rate was 5.45%.
Conclusions:
- Percutaneous LAA occlusion is a safe and effective strategy for AF patients with prior ICH.
- A single antiplatelet therapy approach may be suitable for patients at high risk of recurrent bleeding post-LAA occlusion.
Background:
Intracranial hemorrhage (ICH) represents the most serious complication of oral anticoagulant therapy (OAT) in patients with atrial fibrillation (AF), and AF patients with previous ICH are a challenge for clinicians. Left atrial appendage (LAA) occlusion has emerged as an alternative option for AF patients not suitable for OAT. Currently, few data are available on long term outcomes after LAA occlusion in this population. We evaluated the safety and efficacy of LAA occlusion in a cohort of patients with AF and previous ICH.
Methods:
This is a multicenter, observational, retrospective study involving 5 LAA occlusion centers in Italy. It includes all consecutive patients (n = 120) with previous ICH who underwent LAA occlusion for nonvalvular AF and high thromboembolic risk. Procedural outcomes, post-procedural therapies and 12-months follow-up data were analyzed.
Results:
The device was successfully implanted in 100% of cases, with a 6% of major peri-procedural complications. 59% had a prior ICH during OAT. The sample had a high risk of stroke (5.18%/year) and bleeding (6.62%/year). 30% were discharged on single and 54.2% on dual antiplatelet therapy. The expected annual risk for thromboembolism was 5.1%. Excluding periprocedural ischemic complications, the stroke annual rate was 1.8%. The expected annual risk of bleeding was 6.7%. The observed annual bleeding rate was 5.45%.
Conclusions:
Percutaneous LAA occlusion is an effective option for AF patients and previous intracranial hemorrhage. After LAA occlusion, a single antiplatelet therapy strategy could be considered for patients with the highest risk of recurrent bleeding.
