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Updated: Sep 24, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Ligation Using the AtriClip Device: Single-Center Study of Device Safety and Efficacy
Armin Kiankhooy1, Bing Liem2, Gansevoort H Dunnington1
1Cardiothoracic Surgery, Department of Surgery, Adventist Health-St Helena Hospital, CA, USA.
Insights
The AtriClip device effectively closes the left atrial appendage (LAA) during heart surgery in atrial fibrillation patients, significantly reducing stroke risk. This study shows a 96% success rate with no device-related thrombus, confirming its safety and efficacy.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Devices
Background:
- Atrial fibrillation (AF) increases stroke risk due to potential clots in the left atrial appendage (LAA).
- LAA occlusion during cardiac surgery aims to prevent embolic stroke.
- The optimal LAA occlusion method remains debated.
Purpose of the Study:
- To evaluate the safety and effectiveness of the AtriClip epicardial occlusion device for LAA closure.
- To assess outcomes at 1-year follow-up using transesophageal echocardiography (TEE).
Main Methods:
- Prospective evaluation of 97 cardiac surgical patients with AF undergoing LAA AtriClip placement.
- Assessment of clip placement, successful closure, residual pouch, LAA flow, and device-related thrombus (DRT).
- 1-year follow-up with TEE and 3D imaging.
Main Results:
- Successful LAA closure was achieved in 96% of patients (93/97).
- No instances of clip migration or DRT were observed.
- No postoperative thromboembolic events occurred during the study's TEE follow-up.
Conclusions:
- The AtriClip device offers a safe and effective method for surgical LAA occlusion.
- It demonstrates a high success rate for closure without complications like DRT.
- This occlusion technique is suitable for patients undergoing cardiac ablation procedures.
Abstract:
Objective: Left atrial appendage (LAA) occlusion at the time of cardiac surgery in patients with atrial fibrillation has been shown to reduce the incidence of postoperative embolic stroke. However, the optimal method for LAA occlusion is not universally accepted. We sought to examine the safety and effectiveness of LAA occlusion with the AtriClip epicardial occlusion device. Methods: Cardiac surgical patients with atrial fibrillation who underwent LAA AtriClip placement were evaluated prospectively. Clip placement and clinical outcomes were examined after 1 year of follow-up with transesophageal echocardiography (TEE). The presence of a 10 mm or greater residual pouch, presence of flow into the LAA, or device-related thrombus (DRT) were considered failures. Results: Ninety-seven patients were analyzed. The mean CHA2DS2-VASc score was 2.4 ± 1.4. The postoperative follow-up period ranged from 366 to 1,693 days (mean 685 days or 1.87 years). Seventy-four AtriClips were placed with video-assisted thoracic surgery, whereas 23 were placed via sternotomy or thoracotomy. Successful closure was found in 96% (93 of 97) of patients at follow-up. Failure occurred in 4 patients. No clip migration or DRT was seen on 3-dimensional imaging. Of all 97 patients, 76 (78%) were on presurgical oral anticoagulation, whereas 5 (5.1%) were on postprocedure oral anticoagulation. There were no postoperative thromboembolic events at the time of the study TEE. Conclusions: The AtriClip epicardial surgical occlusion device can provide an excellent rate of successful closure of the LAA during surgical ablation procedures without DRT.
