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Updated: Aug 9, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Initiation and development of a percutaneous left atrial appendage closure programme: A French centre's experience
Emeric Albert1, Tania Puscas2, Gabriel Seret3
1Université Paris Cité, Inserm, PARCC, 75015 Paris, France; Department of Cardiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France.
Insights
Percutaneous left atrial appendage closure is a feasible and beneficial procedure for patients with atrial fibrillation at high risk of stroke and bleeding. This study shows a significant reduction in thromboembolic and bleeding events post-procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Atrial fibrillation necessitates stroke risk management.
- Left atrial appendage closure (LAAC) is an alternative for patients at high risk of both stroke and bleeding.
Approach:
- Retrospective observational cohort study (2014-2020) of 207 patients undergoing LAAC.
- Analysis of procedural success, complications, and long-term thromboembolic and bleeding events.
- Comparison of outcomes with historical incidence rates.
Key Points:
- Successful LAAC in 97.6% of patients.
- Periprocedural complications occurred in 9.7%, with a decrease over time.
- Significant risk reduction for thromboembolic events (72%) and bleeding (31%) during follow-up.
Conclusions:
- LAAC is feasible and beneficial in real-world settings.
- Multidisciplinary expertise is crucial for developing LAAC programs.
- LAAC offers a valuable option for selected high-risk atrial fibrillation patients.
Background:
Percutaneous left atrial appendage closure may be considered in selected patients with atrial fibrillation at significant risk of both thromboembolism and haemorrhage.
Aims:
To report the experience of a tertiary French centre in percutaneous left atrial appendage closure and to discuss the outcomes compared with previously published series.
Methods:
This was a retrospective observational cohort study of all patients referred for percutaneous left atrial appendage closure between 2014 and 2020. Patient characteristics, procedural management and outcomes were reported, and the incidence of thromboembolic and bleeding events during follow-up were compared with historical incidence rates.
Results:
Overall, 207 patients had left atrial appendage closure (mean age 75.3±8.6 years; 68% men; CHA2DS2-VASc score 4.8±1.5 ; HAS-BLED score 3.3±1.1), with a 97.6% (n=202) success rate. Twenty (9.7%) patients had at least one significant periprocedural complication, including six (2.9%) tamponades and three (1.4%) thromboembolisms. Periprocedural complication rates decreased from earlier to more recent periods (from 13% before 2018 to 5.9% after; P=0.07). During a mean follow-up of 23.1±20.2 months, 11 thromboembolic events were observed (2.8% per patient-year), a 72% risk reduction compared with the estimated theoretical annual risk. Conversely, 21 (10%) patients experienced bleeding during follow-up, with almost half of the events occurring during the first 3 months. After the first 3 months, the risk of major bleeding was 4.0% per patient-year, a 31% risk reduction compared with the expected estimated risk.
Conclusion:
This real-world evaluation emphasizes the feasibility and benefit of left atrial appendage closure, but also illustrates the need for multidisciplinary expertise to initiate and develop this activity.
