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Updated: Aug 22, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Heart Team for Left Appendage Occlusion without the Use of Antithrombotic Therapy: The Epicardial Perspective
Stefano Branzoli1,2, Fabrizio Guarracini3, Massimiliano Marini3,4
1Department of Cardiac Surgery, UZ Brussel, 1050 Brussels, Belgium.
Insights
Epicardial appendage occlusion, a procedure for atrial fibrillation patients, effectively prevents strokes without antithrombotic therapy. This approach minimizes bleeding risks, offering a safe alternative for those intolerant to blood thinners.
Area of Science:
- Cardiology
- Minimally Invasive Surgery
Background:
- Left atrial appendage occlusion is a proposed treatment for atrial fibrillation patients intolerant to anticoagulants.
- Endovascular devices typically require antithrombotic therapy due to thrombosis and leak risks.
- Epicardial closure, lacking foreign material, may not need antithrombotic therapy, but large-scale data are scarce.
Purpose of the Study:
- To evaluate the safety and efficacy of standalone totally thoracoscopic epicardial appendage closure without antithrombotic therapy.
- To assess the need for antithrombotic therapy in patients undergoing epicardial appendage occlusion.
Main Methods:
- 180 patients with atrial fibrillation and poor anticoagulant tolerance underwent multidisciplinary evaluation for epicardial appendage closure.
- 152 patients (mean age 76.1 years, high CHA2DS2VASc and HASBLED scores) proceeded with the procedure.
- No antithrombotic therapy was administered post-surgery.
Main Results:
- Procedural success rate was 98.7%.
- At a mean follow-up of 38.2 months, cardioembolic events were 1.3% and bleeding events were 0.6%.
- No further blood transfusions were needed in patients with a history of transfusions.
Conclusions:
- Epicardial appendage occlusion without antithrombotic therapy is safe and effective.
- This strategy is advisable for stroke prevention while minimizing bleeding risk.
Background:
Left atrial appendage occlusion is an increasingly proposed treatment for patients with atrial fibrillation and poor tolerance to anticoagulants. All endovascular devices require antithrombotic therapy. Anatomical and clinical variables predisposing to device-related thrombosis, as well as post-procedural peri-device leaks, could mandate the continuation or reintroduction of aggressive antithrombotic treatment. Because of the absence of foreign material inside the heart, epicardial appendage closure possibly does not necessitate antithrombotic therapy, but data of large series are missing.
Methods:
Multidisciplinary team evaluation for standalone totally thoracoscopic epicardial appendage closure was done in 180 consecutive patients with atrial fibrillation and poor tolerance to antithrombotic therapy. One hundred and fifty-two patients consented (male 66.1%, mean age 76.1 ± 7.4, CHA2DS2VASc mean 5.3 ± 1.6, HASBLED mean 3.8 ± 1.1). Indications were cerebral hemorrhage (48%), gastro-intestinal bleeding (33.3%), and other bleeding (20.7%). No antithrombotic therapy was prescribed from the day of surgery to the latest follow up.
Results:
Procedural success was 98.7%. At a mean follow up of 38.2 ± 18.8 months, cardioembolic and bleeding events were 1.3% and 0.6%, respectively. Among patients with a history of blood transfusions (41.1%), none needed further transfusions or treatment post procedure.
Conclusion:
Epicardial appendage occlusion without any antithrombotic therapy appears to be safe and effective. This strategy could be advised when minimization of bleeding risk concomitant to stroke prevention is needed.
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