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Updated: Oct 19, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Effectiveness and safety of transcatheter left atrial appendage closure
1Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
Insights
Left atrial appendage (LAA) closure offers a stroke prevention alternative to anticoagulation for atrial fibrillation (AF) patients. The WATCHMAN device shows similar efficacy with reduced bleeding, though optimal post-procedure care needs further study.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Atrial fibrillation (AF) is a major cause of cardiogenic stroke.
- Left atrial appendage (LAA) is a primary source of cardiac thrombus in AF patients.
- LAA closure presents a novel stroke prevention strategy as an alternative to anticoagulation.
Purpose of the Study:
- To evaluate the safety and efficacy of LAA closure devices, specifically the WATCHMAN device.
- To compare LAA closure with anticoagulation in terms of thromboembolic and bleeding events.
- To identify areas for improvement in LAA closure procedures and post-procedural management.
Main Methods:
- Review of randomized trials assessing the WATCHMAN LAA Closure device.
- Analysis of procedural complication rates and their reduction with experience.
- Comparison of thromboembolic and bleeding event rates between LAA closure and anticoagulation.
Main Results:
- The WATCHMAN device is approved in the USA and Japan for high-risk non-valvular AF patients.
- LAA closure demonstrated similar thromboembolic event rates but significantly reduced bleeding events compared to anticoagulants.
- Procedural complications, such as cardiac tamponade and device embolization, decrease with implanter experience.
Conclusions:
- LAA closure is a safe and effective stroke prevention method for selected AF patients.
- Further research is needed on optimal post-procedural antithrombotic regimens.
- Addressing device-related thrombosis and tailoring treatment through heart team communication are crucial for optimal patient outcomes.
Abstract:
Atrial fibrillation (AF) is responsible for cardiogenic stroke. Since left atrial appendage (LAA) is a cause of most of cardiac thrombus, LAA closure is an emerging novel stroke prevention procedure for patients with AF alternative to anticoagulation. WATCHMAN LAA Closure device (Boston Scientific, Marlborough, MA, USA) is the only approved device in the USA and Japan. The device is indicated in high bleeding risk and high stroke risk non-valvular AF patients. Cardiac tamponade, stroke, and device embolization are typical procedural complications. Procedural complication rate is reduced with implanters' experience and matured procedure steps. Several randomized trials demonstrated procedure safety and efficacy of the device. The device resulted in similar thromboembolic event rates but significantly reduced bleeding events compared to anticoagulants. After the procedure, optimal post procedural antithrombotic drug regimen has not been fully investigated. Also, device-related thrombosis can be a new issue. Modification of the device can improve issues, but not fully solve it. Tailor made treatment based on the individual risk by heart team communication with neurologists is essential to treat patients.
