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Updated: Oct 16, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage closure: a new strategy for cardioembolic events despite oral anticoagulation
Giulio Falasconi1,2, Carlo Gaspardone3,4, Cosmo Godino3
1Unit of Clinical Cardiology, IRCCS San Raffaele Hospital, Milan, Italy - giuliofalasconi@gmail.com.
Background:
Patients with non-valvular atrial fibrillation (nvAF) who experienced a cardioembolic (CE) event despite adequate oral anticoagulation (OAC) are at high risk of recurrence, and further prevention strategies are deemed necessary. The present study aimed to evaluate the safety and efficacy of off-label use of left atrial appendage closure (LAAC) in this subset of patients.
Methods:
Seventy-five consecutive patients with nvAF who experienced a CE event despite adequate OAC therapy were retrospectively enrolled from two Italian centers. Patients were divided according to the treatment strategy following the index event: DOAC group (49 patients who continued OAC therapy with DOACs) and LAAC group (26 patients who underwent LAAC procedure). 1:1 propensity-score matching between the two groups was performed. LAAC group was made up of two subgroups according to the post-procedural pharmacological regimen: 1) dual antiplatelet therapy (DAPT) for 3 months followed by indefinite single antiplatelet therapy (LAAC+SAPT); or 2) aspirin plus DOAC for 3 months followed by indefinite DOAC therapy (LAAC+DOAC). The primary endpoint was a composite of CE event, major bleeding, or procedure-related major complication.
Results:
During a median follow-up of 3.4 years (IQR: 2.0-5.3), LAAC was a predictor of primary endpoint-free survival (HR=0.28, 95% CI: 0.08-0.97; P=0.044); within LAAC group, no procedure-related major complication occurred. Moreover, a trend toward a lower rate of both CE events and major bleedings was observed in LAAC group, particularly in the subgroup LAAC+DOAC.
Conclusions:
LAAC is a reasonable therapeutic option in nvAF patients who suffered a CE event despite adequate OAC therapy.
Insights
Left atrial appendage closure (LAAC) offers a safe and effective alternative for non-valvular atrial fibrillation (nvAF) patients experiencing cardioembolic events despite oral anticoagulation. This strategy reduces the risk of recurrent events and bleeding.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Research
Background:
- Patients with non-valvular atrial fibrillation (nvAF) experiencing cardioembolic (CE) events despite adequate oral anticoagulation (OAC) face high recurrence risk.
- Novel prevention strategies are crucial for this high-risk patient subset.
- Evaluating off-label left atrial appendage closure (LAAC) offers a potential solution.
Purpose of the Study:
- To assess the safety and efficacy of off-label left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (nvAF).
- To compare outcomes between patients treated with DOACs versus those undergoing LAAC after a cardioembolic event.
- To analyze the impact of different post-procedural pharmacological regimens on LAAC outcomes.
Main Methods:
- Retrospective analysis of 75 nvAF patients with prior CE events despite OAC, treated at two Italian centers.
- Comparison between a DOAC group (n=49) and an LAAC group (n=26) using propensity-score matching.
- Subgroup analysis within the LAAC group based on post-procedural therapy: dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT), or aspirin plus DOAC.
Main Results:
- Left atrial appendage closure (LAAC) was associated with improved primary endpoint-free survival (HR=0.28).
- No procedure-related major complications occurred in the LAAC group.
- A trend towards lower rates of CE events and major bleeding was observed in the LAAC group, particularly with the LAAC+DOAC regimen.
Conclusions:
- Left atrial appendage closure (LAAC) represents a viable therapeutic option for nvAF patients who experience cardioembolic events despite adequate oral anticoagulation.
- LAAC demonstrates a favorable safety profile and a trend towards improved clinical outcomes in this high-risk population.
- The combination of LAAC with DOAC therapy warrants further investigation for optimal management.
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