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Updated: Nov 27, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous left atrial appendage occlusion
Moghniuddin Mohammed1,2, Sagar Ranka1, Madhu Reddy1
1Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas.
Insights
Left atrial appendage occlusion (LAAO) is a safe and effective long-term therapy for nonvalvular atrial fibrillation patients unable to use oral anticoagulation. Recent trials show LAAO is noninferior to direct oral anticoagulants.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- Left atrial appendage occlusion (LAAO) offers an alternative anticoagulation strategy.
- Growing evidence supports LAAO for patients ineligible for long-term oral anticoagulation (OAC).
Purpose of the Study:
- Review recent evidence on long-term safety and efficacy of LAAO.
- Evaluate current guideline recommendations for LAAO.
- Compare LAAO performance against direct oral anticoagulants (DOACs).
- Assess a recently approved LAAO device.
Main Methods:
- Review of recent clinical trial data and registry outcomes.
- Analysis of guideline recommendations.
- Comparison of LAAO with DOACs based on existing studies.
- Evaluation of new device performance data.
Main Results:
- Long-term data confirm LAAO as safe and effective for nonvalvular atrial fibrillation (NVAF) patients.
- Class IIb recommendation for LAAO in NVAF patients not eligible for long-term OAC.
- PRAGUE-17 trial: LAAO noninferior to DOACs.
- PINNACLE FLX trial: improved implant success and closure rates.
Conclusions:
- Percutaneous LAAO is a promising option for NVAF patients unsuitable for long-term OAC.
- Further research needed for optimal patient selection and periprocedural antithrombotic regimens.
Purpose Of Review:
To review recent evidence evaluating the long-term safety and efficacy outcomes of left atrial appendage occlusion (LAAO), current guideline recommendations for LAAO use, performance of LAAO in comparison with direct oral anticoagulants (DOAC) and recently approved LAAO device.
Recent Findings:
The last 18 months have been marked with increasing evidence of the utility of LAAO in patients who are not candidates for long-term oral anticoagulation (OAC). Long-term data from two continued access registries to PROTECT-AF and PREVAIL support LAAO as a safe and effective long-term anticoagulation therapy. This new evidence led to class IIb recommendation for LAAO in nonvalvular atrial fibrillation (NVAF) patients not eligible for long-term OAC. PRAGUE-17 randomized controlled trial showed LAAO is noninferior to DOAC lending support to use of this modality in current era. PINNACLE FLX trial showed improved implant success and adequate closure rate which led to the device's Food and Drug Administration approval.
Summary:
In conclusion, percutaneous LAAO appears to be a promising option for NVAF patients who are not candidates for long-term OAC in the current era. Further evidence guiding optimal patient selection and periprocedural antithrombotic regimen will help identify the patients who would benefit the most from this procedure.
