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Updated: Oct 11, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Outcome of left atrial appendage closure using cerebral protection system for thrombosis: no patient left behind
Luca Rosario Limite1, Andrea Radinovic1, Lorenzo Cianfanelli2
1Department of Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Insights
Percutaneous left atrial appendage closure (LAAC) using a cerebral protection device (CPD) is safe and effective for managing left atrial appendage thrombosis or sludge (LAAT). This approach offers a viable therapeutic option for patients at risk of stroke.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Management
Background:
- Left atrial appendage (LAA) thrombosis poses a significant stroke risk, necessitating effective management strategies.
- Left atrial appendage thrombosis or sludge (LAAT) can occur despite anticoagulant therapy or after its withdrawal due to bleeding complications.
Purpose of the Study:
- To evaluate the safety and efficacy of a standardized percutaneous left atrial appendage closure (LAAC) approach.
- To assess the routine use of a cerebral protection device (CPD) during LAAC in patients with LAAT.
Main Methods:
- Prospective enrollment of 14 consecutive patients with atrial fibrillation and LAAT.
- Standardized LAAC procedure using a CPD, guided by transesophageal echocardiography.
- Transradial access was utilized in the majority of patients (92.8%).
Main Results:
- Procedural success was achieved in all patients, with no reported neurological consequences despite one instance of thrombus embolization.
- The study included patients with high stroke risk (CHA2DS2-VASc score 3.3 ± 1.6) and bleeding risk (HAS-BLED score 2.3 ± 1.1).
- During a mean follow-up of 426 days, no embolic events or major bleeding were reported; one patient died from a non-cardiac cause.
Conclusions:
- Percutaneous LAAC with routine CPD use is a feasible, safe, and effective therapeutic option for LAAT.
- The approach demonstrated both acute and long-term safety and efficacy in an unselected patient cohort.
Background:
Left atrial appendage (LAA) thrombosis increases the risk of stroke and its management has to be assessed. The aim of the present study is to evaluate short and long-term safety and efficacy of a standardized approach of percutaneous LAA closure (LAAC) routinely using a cerebral protection device (CPD) in patients with LAA thrombosis or sludge (LAAT).
Methods:
We prospectively enrolled 14 consecutive patients with atrial fibrillation complicated by LAAT presenting in a high-volume tertiary center. In seven patients (50%) LAAT was found after anticoagulant withdrawal for severe bleedings and in the remaining half LAAT was found despite appropriate anticoagulant therapy. All patients were treated with a standardized interventional approach of LAAC routinely using a CPD and guided by transoesophageal echocardiography.
Results:
Mean age was 68 ± 14 years and nine patients (64%) were male. Mean CHA2 DS2 -VASc and HAS-BLED scores were 3.3 ± 1.6 and 2.3 ± 1.1, respectively. Six patients (42.8%) presented organized thrombi while eight LAA sludge (57.1%). In 13 patients (92.8%) CPD was positioned through a right radial arterial access. Procedural success was achieved in all patients. In one patient we assisted to embolization of the thrombus during deployment of the device in the absence of neurological consequences. During a mean follow up of 426 ± 307 days, one patient died for non-cardiac cause while no embolic event or major bleeding were reported.
Conclusion:
In an unselected cohort, LAAC with the systematic use of CPD was a feasible, safe and effective therapeutic option for LAAT both acutely and after long-term follow-up.
