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Updated: Sep 3, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Combined MitraClip and Left Atrial Appendage Occlusion: Is It Still a Utopia?
Martina Belli1, Federico Zanin1, Massimiliano Macrini2
1Department of Systems Medicine, University Tor Vergata, Rome, Italy.
Insights
Atrial fibrillation (AF) patients with bleeding risks can benefit from combined Left Atrial Appendage Occlusion (LAAO) and MitraClip. Further research is needed to identify optimal patient selection and long-term outcomes for this combined therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Atrial fibrillation (AF) is a prevalent arrhythmia, increasing stroke risk, especially in the elderly.
- Oral anticoagulation (OAC) is standard for stroke prevention but contraindicated in some patients due to bleeding risk.
- Moderate-to-severe mitral regurgitation (MR) frequently co-occurs with AF, and many patients are inoperable.
Purpose of the Study:
- To explore the potential of combined Left Atrial Appendage Occlusion (LAAO) and MitraClip procedures for AF patients with contraindications to OAC.
- To highlight the clinical need for improved patient selection for combined percutaneous therapies.
- To investigate the role of advanced cardiovascular imaging in optimizing patient selection.
Main Methods:
- Review of current literature on AF, OAC, MR, LAAO, and MitraClip procedures.
- Discussion of the limitations in identifying suitable candidates for combined percutaneous interventions.
- Exploration of the potential utility of 3D echocardiography and volume imaging for patient selection.
Main Results:
- A significant population of AF patients with bleeding risks and severe MR are not surgical candidates.
- Combined LAAO and MitraClip presents a promising therapeutic avenue for this challenging patient group.
- Current data on the efficacy, safety, and optimal patient selection for combined procedures are limited.
Conclusions:
- Combined percutaneous LAAO and MitraClip may offer a solution for high-risk AF patients unsuitable for OAC or surgery.
- Further research, including prospective studies, is essential to establish the long-term efficacy and safety of this combined approach.
- Advanced imaging techniques are crucial for refining patient selection and maximizing the benefits of these interventions.
Abstract:
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting 32 million individuals worldwide, particularly the elderly. It is the main cause of ischemic strokes. Oral anticoagulation (OAC) is the gold standard strategy for stroke prevention. Still, there is a not negligible share of patients who have contraindications to this therapy, more frequently due to an increased risk of bleeding. AF is often associated with moderate-severe mitral regurgitation (MR), the second most frequent valvular disease in elderly patients. Data from the literature reported that more than half of patients with severe mitral regurgitation are not suitable candidates for cardiac surgery. Given the progressive aging of the population and the simultaneous increase in the number of patients with comorbidities, the advent of new therapeutic strategies, such as the combined approach of Left Atrial Appendage Occlusion (LAAO) and MitraClip procedure, is acquiring great interest. At present, the category of patients who may benefit from combined percutaneous therapies and the long-term risks and benefits might not have been identified. Despite the efforts of researchers, the correct selection of patients is a very important clinical need that has not yet been met to avoid committing human and financial resources to interventions that may be unnecessary. It is conceivable that the most modern and recent innovations in cardiovascular imaging, particularly three-dimensional echocardiography and new methods of volume imaging, could improve our ability to select patients appropriately. Since data in the literature are scarce, future studies will be needed to evaluate the efficacy and safety of combined MitraClip and LAA occlusion.
