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Updated: Oct 12, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous left atrial appendage closure in patients with primary hemostasis disorders and atrial fibrillation
Nicolas Dognin1, Erwan Salaun2, Catherine Champagne2
1Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada. nicolas-philippe.dognin.1@ulaval.ca.
Insights
Percutaneous left atrial appendage closure (LAAC) is safe and effective for patients with non-valvular atrial fibrillation and primary hemostasis disorders. This procedure offers comparable stroke and bleeding prevention to the general LAAC population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Hematology
Background:
- Non-valvular atrial fibrillation (NVAF) poses a stroke risk, often managed with anticoagulation.
- Primary hemostasis disorders (HD) complicate anticoagulation strategies.
- Left atrial appendage closure (LAAC) offers an alternative stroke prevention method.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous LAAC in patients with NVAF and primary HD.
- To compare outcomes of LAAC in patients with HD versus those without HD.
Main Methods:
- Single-center retrospective study of consecutive patients with primary HD undergoing percutaneous LAAC.
- Prospective collection of baseline characteristics, procedural data, and clinical outcomes.
- Comparison with a matched cohort of LAAC patients without HD.
Main Results:
- 17 patients (7%) with primary HD (thrombocytopenia, myelodysplastic syndrome, von Willebrand syndrome, hemophilia A, dysfibrinogenemia) underwent LAAC.
- High immediate LAAC implantation success rate (100%) and midterm technical/procedural success (100%/94%).
- Comparable efficacy and safety outcomes (stroke and bleeding prevention) between HD and non-HD groups, despite higher need for perioperative transfusions in the HD group.
Conclusions:
- Percutaneous LAAC is a safe and effective stroke prevention strategy for patients with NVAF and primary HD.
- Midterm follow-up shows comparable safety and efficacy to the general LAAC population.
- A multidisciplinary approach involving cardiology, anesthesiology, and hematology is crucial for optimal management.
Background Or Purpose:
We report our single-center experience with percutaneous left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF) and primary hemostasis disorders (HD).
Methods:
Consecutive patients with primary HD who underwent a percutaneous LAAC were included. Baseline characteristics, procedural data, and clinical outcomes were prospectively collected and compared with the overall LAAC cohort without HD.
Results:
Since 2013, among 229 LAAC, 17 patients (7%) had a primary HD: thrombocytopenia (n = 5), myelodysplastic syndrome (n = 6), von Willebrand syndrome (n = 4), type A hemophilia (n = 1), and dysfibrinogenemia (n = 1). The HD population's age ranged from 61 to 87 years, and the median CHA2DS2VASc was 5. Periprocedural plasmatic management was required in 47% of patients. The immediate LAAC implantation success rate was 100%. Patients received a direct oral anticoagulant (DOA) (n = 9), dual antiplatelet (n = 6), aspirin (n = 1), or no therapy (n = 1) during the first six postoperative weeks, followed with single antiplatelet (n = 16) or no therapy (n = 1) during lifelong. After 20 months, the technical success rate and procedural success rate were 100% and 94%. Zero device-/procedure-related complication and only one life-threatening bleeding occurred. Compared to patients without HD (n = 212), a baseline history of bleeding was less frequent (53% vs 91%, p < 0.001), and more patients received a perioperative blood transfusion (47% vs 4%, p < 0.001) in the HD group. The efficacy and safety outcomes did not differ between HD and non-HD cohorts.
Conclusions:
Percutaneous LAAC in primary HD carriers appeared as safe and as effective as in overall LAAC population for stroke and bleeding prevention at midterm follow-up. Percutaneous left atrial appendage closure in patients with atrial fibrillation and primary hemostasis disorders. The percutaneous LAAC in primary hemostasis disorders and AF carriers requires a multidisciplinary approach. Cardiologist, anesthesiologist, and hematologist discussion is a cornerstone to assess anticoagulant contraindication, LAAC feasibility, periprocedural management, and follow-up (high). This multidisciplinary care is illustrated by the case of a 61-year-old male with hemophilia type A and recurrent hemarthrosis. Pre-LAAC assessment confirmed procedural indication and cactus LAA anatomy (left). After plasmatic management with factor VIII infusion, a WATCHMAN™ no. 21 was successfully implanted (middle). During follow-up, without antithrombotic regime, no ischemic or hemorrhagic complication occurred (right). LAA, left atrial appendage; LAAC, left atrial appendage closure; TEE, transesophageal echocardiography. Percutaneous LAAC in primary HD carriers appeared as safe and as effective as in overall LAAC population for stroke and bleeding prevention at midterm follow-up.
