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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
Standalone epicardial left atrial appendage exclusion for thromboembolism prevention in atrial fibrillation
Richard Cartledge1, Grzegorz Suwalski2, Anna Witkowska3
1Cardiovascular and Thoracic Surgery, Lynn Heart and Vascular Institute Baptist Health South Florida Boca Raton Regional Hospital, Boca Raton, FL, USA.
Insights
Left atrial appendage exclusion (LAAE) is a safe and feasible surgical option for reducing stroke risk in atrial fibrillation (AF) patients. This thoracoscopic procedure significantly lowers the stroke rate compared to predicted risks in high-risk individuals.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Atrial Fibrillation Management
Background:
- Atrial fibrillation (AF) commonly leads to strokes originating from the left atrial appendage.
- Oral anticoagulation is effective but carries risks and compliance issues.
- Left atrial appendage exclusion (LAAE) offers a novel surgical approach to mitigate AF-related stroke risk.
Purpose of the Study:
- To assess the safety and feasibility of standalone thoracoscopic LAAE.
- To evaluate clinical outcomes and stroke rates in high-risk AF patients undergoing LAAE.
Main Methods:
- Retrospective, multicenter study of high-risk AF patients with contraindications to anticoagulation or other cardiac procedures.
- Standalone thoracoscopic LAAE performed using minimally invasive techniques (3 unilateral ports, epicardial clip).
- Evaluation of periprocedural adverse events, long-term clinical outcomes, and stroke incidence.
Main Results:
- High procedural success rate of 99.4% (174/175 patients).
- Low complication rates: pleural effusion (2.3%), other complications <1%. No phrenic nerve palsy or cardiac tamponade.
- Significantly reduced observed stroke rate (0/100 patient-years) compared to predicted risk (4.8/100 patient-years) in patients with a median CHA2DS2-VASc score of 4.0.
Conclusions:
- Standalone thoracoscopic LAAE is a feasible and safe surgical intervention.
- This procedure effectively reduces long-term stroke risk in high-risk AF patients.
- LAAE presents a viable alternative for stroke prevention in AF patients unsuitable for anticoagulation or other treatments.
Objectives:
Most strokes associated with atrial fibrillation (AF) result from left atrial appendage thrombi. Oral anticoagulation can reduce stroke risk but is limited by complication risk and non-compliance. Left atrial appendage exclusion (LAAE) is a new surgical option to reduce stroke risk in AF. The study objective was to evaluate the safety and feasibility of standalone thoracoscopic LAAE in high stroke risk AF patients.
Methods:
This was a retrospective, multicentre study of high stroke risk AF patients who had oral anticoagulation contraindications and were not candidates for ablation nor other cardiac surgery. Standalone thoracoscopic LAAE was performed using 3 unilateral ports access and epicardial clip. Periprocedural adverse events, long-term observational clinical outcomes and stroke rate were evaluated.
Results:
Procedural success was 99.4% (174/175 patients). Pleural effusion occurred in 4 (2.3%) patients; other periprocedural complications were <1% each. One perioperative haemorrhagic stroke occurred (0.6%). No phrenic nerve palsy or cardiac tamponade occurred. Predicted annual ischaemic stroke rate of 4.8/100 patient-years (based on median CHA2DS2-VASc score of 4.0) was significantly higher than stroke risk observed in follow-up after LAAE. No ischaemic strokes occurred (median follow-up: 12.5 months), resulting in observed rate of 0 (95% CI 0-2.0)/100 patient-years (P < 0.001 versus predicted). Six all-cause (non-device-related) deaths occurred during follow-up.
Conclusions:
Study proved that a new surgical option, standalone thoracoscopic LAAE, is feasible and safe. With this method, long-term stroke rate may be reduced compared to predicted for high-risk AF population.
