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Updated: Oct 18, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Long-term outcome of left atrial appendage occlusion with multiple devices
Andrea Radinovic1, Giulio Falasconi1, Alessandra Marzi1
1Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Vita-Salute University and San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy.
Insights
Left atrial appendage occlusion (LAAO) effectively reduces long-term stroke and bleeding risks in high-risk atrial fibrillation patients. Multiple devices demonstrated comparable safety and efficacy, often without requiring anticoagulation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Atrial fibrillation (AF) poses a significant risk for stroke and bleeding events.
- Left Atrial Appendage Occlusion (LAAO) is an alternative to oral anticoagulation for stroke prevention in AF patients.
- Evaluating the long-term outcomes of LAAO using various devices is crucial for clinical practice.
Purpose of the Study:
- To assess the long-term efficacy and safety of Left Atrial Appendage Occlusion (LAAO) using multiple device types.
- To compare the outcomes of different LAAO devices in patients with high risk of stroke and bleeding.
- To determine the long-term effectiveness of LAAO in reducing thromboembolic and bleeding events without oral anticoagulation.
Main Methods:
- A retrospective registry of 224 consecutive patients undergoing LAAO with at least 4 years of follow-up.
- Inclusion of patients treated with Watchman, Watchman FLX, Amplatzer Cardiac Plug, or Amplatzer Amulet occluder devices.
- Analysis of stroke, thromboembolic, and major bleeding events compared to historic data.
Main Results:
- LAAO demonstrated significant reductions in strokes (72.9%), thromboembolic events (59.7%), and major bleeding events (70.9%).
- No significant differences in outcomes were observed between the different LAAO devices used.
- The primary long-term antithrombotic strategy involved single antiplatelet therapy or no therapy.
Conclusions:
- Left Atrial Appendage Occlusion (LAAO) is a safe and effective long-term procedure for AF patients at high risk.
- The choice of LAAO device did not significantly impact long-term outcomes.
- LAAO offers a viable alternative to anticoagulation, reducing both ischemic and bleeding complications.
Background:
To evaluate long-term efficacy of left atrial appendage occlusion with multiple devices.
Methods:
All consecutive patients who underwent left atrial appendage occlusion (LAAO) with a follow-up of at least 4 years, were included in this single center, retrospective registry. No specific exclusion criteria were applied. LAA occlusion was performed with the Watchman, Watchman FLX, Amplatzer Cardiac plug or Amplatzer Amulet occluder devices.
Results:
A total of 224 consecutive patients underwent LAAO occlusion. Mean age was 72.5 ± 9.0 years. A history of stroke was present in 29%, TIA in 8.5% and a previous episode of bleeding in 64.7% of patients. In 63% there was a contraindication to oral anticoagulants. The average CHADS-VASc was 4.0 ± 1.6 and the average HAS-BLED was 3.4 ± 1.3. There was a reduction of strokes of 72.9%, thromboembolic events of 59.7% and major bleeding events of 70.9% compared to historic data. During follow-up, 48.3% of the ischemic and major bleeding events occurred within the first year. The annual mortality rate of 7.5 deaths/ 100 patients years. There were no significant differences in terms of outcome between the devices used and there were no late events associated with any device. The main antithrombotic regimen in the long term was with single antiplatelet therapy and the second one was no therapy.
Conclusion:
LAAO is a safe and effective procedure, that reduces ischemic and bleeding events in the long-term, regardless of the type of device used, in AF patients at high risk of ischemic stroke and major bleeding, without the need of anticoagulation.
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