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Updated: Aug 28, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous Left Atrial Appendage Closure with the LAmbre Device Protected by a Cerebral Protection System in a
Sorin Ștefan Popescu1,2, Christian-Hendrik Heeger1,3, Ahmad Keelani1
1Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.
Insights
Left atrial appendage (LAA) thrombus in atrial fibrillation (AF) patients can be challenging. Percutaneous LAA closure with a cerebral protection system (CPS) may offer a safe alternative when anticoagulation fails.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Persistent left atrial appendage (LAA) thrombus is a complication in atrial fibrillation (AF) patients despite optimal anticoagulation.
- Limited therapeutic options exist for AF patients with persistent LAA thrombus.
- Percutaneous LAA closure (LAAC) is typically contraindicated in the presence of LAA thrombus due to embolism risk.
Observation:
- A 76-year-old male with persistent AF and LAA thrombus, resistant to apixaban and phenprocoumon, underwent LAAC.
- The procedure utilized the LAmbre device and the SENTINEL Cerebral Protection System (CPS).
- Transesophageal echocardiography confirmed persistent LAA thrombus despite therapeutic anticoagulation levels.
Findings:
- Percutaneous LAAC was successfully performed using a double-umbrella occluder and CPS.
- The procedure was guided by transesophageal echocardiography and fluoroscopy.
- No systemic thromboembolism or thrombotic material in CPS filters was observed.
Implications:
- Using a CPS during LAAC may mitigate the risk of intraprocedural cerebral embolization.
- This approach could serve as an alternative therapy for patients with LAA thrombus and contraindications or failure of oral anticoagulation.
- Further research is warranted to evaluate the efficacy and safety of CPS-assisted LAAC in this patient population.
Abstract:
BACKGROUND Despite use of optimal oral anticoagulation regimens, left atrial appendage (LAA) thrombus may develop and persist in patients with atrial fibrillation (AF). The therapeutic options in this population are limited. Percutaneous LAA closure (LAAC) is performed to reduce thrombus formation and the risk of thromboembolism. However, this approach is prohibited in patients with LAA thrombus. We report the case of a 76-year-old man with AF and persistent LAA thrombus who underwent percutaneous LAAC with the LAmbre device protected by the SENTINEL Cerebral Protection System (CPS). CASE REPORT A 76-year-old man with history of persistent AF treated with pulmonary veins and LAA isolation developed LAA thrombus resistant to different anticoagulation therapies, including apixaban and Phenprocoumon, with a target international normalized ratio (INR) of 3-3,5. Repeated follow-up transesophageal echocardiography showed a persistent LAA thrombus despite optimal INR values. Thus, we performed a percutaneous LAAC using a double-umbrella-designed appendage occluder and a CPS to minimize the risk of intraprocedural cerebral embolization. The procedure was guided by transesophageal echocardiography and fluoroscopy. No signs of systemic thromboembolism were noted, and the CPS filters showed no evidence of thrombotic material. CONCLUSIONS This report shows that the use of a CPS during percutaneous LAAC may reduce the risk of procedural cerebral embolization and could be used as an alternative therapy for patients with contraindication or lack of effectiveness of oral anticoagulation.
