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Updated: Oct 1, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Efficacy and Safety of a Dedicated Left Atrial Appendage Occlusion Protocol
Leontin Lazar1, Erick Francisco Sanchez-Jimenez1, Bernardo Cortese2
1Interventional Cardiology, Cardiovascular Research Group, Clinica Polispecialistica San Carlo, Milano, Italy.
Insights
This study presents a new protocol for left atrial appendage closure in frail patients, demonstrating its safety and effectiveness. The strategy involves superficial sedation and tailored antithrombotic therapy, reducing risks associated with stroke prevention in high-comorbidity individuals.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- Atrial fibrillation (AF) poses a significant stroke risk due to left atrial appendage (LAA) thromboembolism.
- Existing protocols for LAA occlusion in frail patients with comorbidities lack standardization, particularly regarding anesthesia and post-procedure management.
- A dedicated protocol is needed to optimize LAA occlusion outcomes in high-risk populations.
Purpose of the Study:
- To introduce and evaluate a specialized protocol for percutaneous left atrial appendage (LAA) occlusion in frail patients.
- To assess the safety and efficacy of this protocol, focusing on anesthesia and antithrombotic strategies.
- To describe the mid-term outcomes of LAA occlusion using this tailored approach.
Main Methods:
- 32 patients underwent percutaneous LAA occlusion guided by transesophageal echocardiography.
- Superficial sedation was employed, with general anesthesia used in one case.
- A personalized antithrombotic regimen was administered based on individual bleeding and thrombotic risk profiles.
- Echocardiography follow-up was conducted at 3 months.
Main Results:
- Procedural success was achieved in 31 out of 32 patients (96.9%).
- No in-hospital complications were observed.
- One case of asymptomatic device thrombosis occurred, managed with 30-day anticoagulation.
- During an average follow-up of 10.3 months, there were no deaths, strokes, or major bleeding events.
Conclusions:
- A tailored post-implantation antithrombotic regimen is safe and effective for frail patients undergoing LAA occlusion.
- Avoiding general anesthesia in favor of superficial sedation is a viable strategy for this patient group.
- Percutaneous LAA occlusion with this dedicated protocol offers a promising approach for stroke prevention in frail individuals.
Objectives:
The aim of this study is to present a dedicated left atrial appendage closure protocol, which could be of great interest in the approach of frail patients.
Background:
Left atrial appendage (LAA) occlusion emerged as a promising therapeutic tool for stroke prevention, as most of the atrial fibrillation (AF) related strokes result from LAA thromboembolism, with an important residual risk even for anticoagulated patients. As an internationally recognized and scientifically-based protocol for the patients with higher comorbidities has not yet been defined for this procedure in terms of anaesthesia use or post procedural antithrombotic therapy and follow-up, we developed a dedicated protocol that could be applied in frail patients. In this study we describe the mid-term outcome of our strategy.
Methods:
We enrolled 32 patients that underwent percutaneous LAA occlusion under transesophageal echocardiogram guidance, using only superficial sedation. A dedicated anti-thrombotic regimen was chosen for all patients, taking into consideration their bleeding and thrombotic risk profile. All patients routinely performed echocardiography after 3 months follow-up.
Results:
Procedural success was achieved in all cases, except for one, due to extreme angulation of the LAA neck, while one patient required general anaesthesia. Only 9.4% of the patients, having previous stroke and still at high risk for cardio-embolic events, continued anticoagulation, while 31.2% discontinued any anti-thombotic drug. While no in-hospital complication was encountered, we found one asymptomatic device-thrombosis, managed by 30 days anticoagulation. No deaths, strokes or major bleedings occurred during an average 10.3 months of follow-up.
Conclusions:
A tailored post-implantation anti-thrombotic regimen and the avoidance of general anaesthesia can be a safe and effective strategy for the usually frail patients requiring percutaneous LAAO.
