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Updated: Nov 21, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

33.7K

Impact of anticoagulation strategy after left atrial appendage occlusion in patients requiring direct current

Moniek Maarse1,2, Lisette I S Wintgens1,2, Andrey Ponomarenko3

  • 1Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.

Journal of Cardiovascular Electrophysiology
|January 15, 2021
PubMed

Insights

Direct current cardioversion (DCCV) is safe and effective for atrial fibrillation (AF) patients post-left atrial appendage occlusion (LAAO). No thrombo-embolic events occurred, regardless of anticoagulation or imaging strategy, highlighting DCCV

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Current guidelines recommend extensive anticoagulation for direct current cardioversion (DCCV) in atrial fibrillation (AF) patients to prevent thrombo-embolic events.
  • No specific guidelines exist for DCCV in patients who have undergone left atrial appendage occlusion (LAAO), many of whom cannot use anticoagulation.
  • This gap necessitates evaluating DCCV safety and efficacy in the post-LAAO population.

Purpose of the Study:

  • To assess the efficacy and safety of direct current cardioversion (DCCV) in patients following left atrial appendage occlusion (LAAO).
  • To analyze various imaging and anticoagulation strategies employed around DCCV in this patient group.
  • To compare DCCV procedures adhering to general AF guidelines versus those deviating from them.

Main Methods:

  • A prospective multicenter registry collected data on DCCVs performed in patients post-LAAO.
  • Imaging strategies, anticoagulation treatments, and 30-day follow-up complications were analyzed.
  • Procedures were categorized based on adherence to current AF guidelines.

Main Results:

  • 284 DCCVs were performed in 93 patients; sinus rhythm was restored in 271 instances.
  • No thrombo-embolic events were observed within 30 days post-DCCV across all analyzed strategies.
  • Two cases of device rotation or embolization occurred in patients without pre-DCCV imaging to verify device position.

Conclusions:

  • Direct current cardioversion (DCCV) is a highly effective procedure for atrial fibrillation (AF) patients after left atrial appendage occlusion (LAAO).
  • The study found no thrombo-embolic events, irrespective of anticoagulation or imaging protocols used.
  • Verifying adequate left atrial appendage device positioning before DCCV is recommended.
Abstract

Keywords:
atrial fibrillationcerebrovascular accidentdirect current cardioversionleft atrial appendage occlusionstrokethrombo-embolic event

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