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Updated: Sep 22, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous left atrial appendage occlusion: A South African experience
A P Dippenaar1, J A Saaiman, P A Brink
1SAEndovascular, Kuils River Netcare Hospital, Kuils River, Cape Town, South Africa. dradippenaar@gmail.com.
Insights
Percutaneous left atrial appendage occlusion (LAAO) in South Africa shows safety and efficacy comparable to international studies. This minimally invasive procedure is a viable alternative for patients with atrial fibrillation (AF) unsuitable for oral anticoagulants.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Atrial fibrillation (AF) increases mortality, heart failure, and stroke risk, often managed with oral anticoagulants (OACs).
- Percutaneous left atrial appendage occlusion (LAAO) offers an alternative thromboprophylaxis for AF patients intolerant, non-adherent, or at high bleeding risk with OACs.
- Previous trials like PROTECT AF demonstrated LAAO's non-inferiority to OACs, but local South African data were scarce.
Purpose of the Study:
- To evaluate the safety and efficacy of a percutaneous LAAO program in South Africa.
- To compare outcomes of the South African LAAO program with established international series.
- To assess the feasibility of LAAO in a Southern African healthcare setting.
Main Methods:
- Analysis of patients undergoing percutaneous LAAO from 2013-2020 at a single South African center.
- Utilized data from an ongoing registry and performed survival analysis with the Kaplan-Meier method.
- Included 101 patients with various forms of AF, focusing on indications, device specifics, procedural success, and adverse events.
Main Results:
- The study included 101 patients (mean age 77 years, 64% male), predominantly with permanent AF (90%).
- The primary indication for LAAO was previous severe bleeding (23%). Procedural success was high (98%) with a mean device size of 23 mm.
- After a median follow-up of 21 months, 6% experienced stroke or all-cause mortality, and 4% had life-threatening complications (tamponade, device embolisation), comparable to international data.
Conclusions:
- Percutaneous LAAO in South Africa demonstrated safety and efficacy comparable to large international studies.
- The findings support the feasibility of establishing and maintaining a successful percutaneous LAAO program within a Southern African context.
- LAAO presents a viable thromboprophylactic option for selected AF patients in South Africa.
Background:
Atrial fibrillation (AF) is associated with all-cause mortality, heart failure and non-fatal stroke, and thromboprophylaxis is traditionally provided with oral anticoagulants (OACs). Percutaneous left atrial appendage occlusion (LAAO) with a dedicated device is an alternative approach to thromboprophylaxis in patients with AF who are: (i) intolerant to OACs (e.g. life-threatening haemorrhage); (ii) non-adherent to OACs; or (iii) at a high bleeding risk with OACs. Non-inferiority of LAAO compared with OACs was demonstrated in e.g. the WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation (PROTECT AF) trial. Only very limited data are available on percutaneous LAAO in South Africa (SA), and no local outcome data have been reported.
Objectives:
To compare the safety and efficacy outcomes of an SA percutaneous LAAO programme with larger international series.
Methods:
All patients undergoing percutaneous LAAO from 2013 to 2020 at a single centre (SAEndovascular, Kuils River Netcare Hospital, SA) were included from an ongoing registry. Survival analysis was performed with the Kaplan-Meier method.
Results:
Of 101 LAAO recipients (mean (standard deviation) age 77 (10) years, 64% male) analysed, 90 (90%) had permanent AF, 1 (1%) persistent AF and 9 (9%) paroxysmal AF. The most common indication for LAAO was previous severe bleeding (n=23; 23%). The mean device size was 23 (3) mm and the procedural success rate was 98%. After a median (interquartile range) follow-up of 21 (5 - 41) months, 6 patients (6%) experienced stroke or all-cause mortality. Four patients (4%) had a life-threatening procedural complication (tamponade n=2 (2%) and device embolisation n=2 (2%)). These outcomes are comparable to large international series, e.g. PROTECT AF.
Conclusions:
The safety and efficacy outcomes of an SA percutaneous LAAO programme were comparable to large international series. A successful percutaneous LAAO programme is feasible in a southern African context.
