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Updated: Sep 5, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

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[Left atrial appendage occlusion as replacement of coumarin anticoagulants in calciphylaxis]

Maria Andolfatto1, Marianna Tangredi1, Margherita Vischi1

  • 1Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Italy.

Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia
|July 12, 2022
PubMed

Insights

Calcific uremic arteriolopathy (CUA), a rare kidney failure complication, is linked to coumarin anticoagulant therapy. Left atrial appendage occlusion may replace this therapy in dialysis patients with atrial fibrillation.

Area of Science:

  • Nephrology
  • Cardiology
  • Vascular Medicine

Background:

  • Calcific uremic arteriolopathy (CUA), or calciphylaxis, affects 1-4% of patients with end-stage renal disease on dialysis.
  • The exact pathogenesis of CUA remains unclear, but risk factors are being identified.
  • Coumarin anticoagulant therapy (tAC) is a recognized risk factor for CUA development.

Purpose of the Study:

  • To highlight the contraindication of tAC in patients who develop CUA.
  • To propose alternative anticoagulation strategies for dialysis patients with non-valvular atrial fibrillation (NVAF) at risk of CUA.
  • To emphasize the need for multidisciplinary team involvement in managing these complex cases.

Main Methods:

  • Literature review of CUA pathogenesis and risk factors.
  • Analysis of anticoagulation strategies in dialysis patients with NVAF.
  • Clinical case discussion framework for CUA management.

Main Results:

  • tAC is contraindicated once CUA is diagnosed due to potential exacerbation.
  • Left atrial appendage occlusion (LAAO) presents a viable alternative to tAC in dialysis patients with NVAF.
  • Management requires careful consideration by nephrologists and a multidisciplinary team.

Conclusions:

  • Dialysis patients with NVAF require careful anticoagulation management to prevent CUA.
  • LAAO is a potential alternative to tAC in selected dialysis patients with NVAF.
  • A collaborative, multidisciplinary approach is essential for optimal CUA patient care.

Keywords:
CalciphylaxisWarfarinanticoagulant therapychronic kidney diseaseleft atrial appendage occlusion

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