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Updated: Jul 12, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Combination of percutaneous left appendage epicardial ligation and endo-epicardial atrial fibrillation ablation
Stefano Grossi1, Francesca Bianchi1, Alessandro Blandino1
1Cardiology Department, AO Ordine Mauriziano, Turin, Italy.
Insights
This study combined left atrial appendage (LAA) ligation and endo-epicardial ablation for atrial fibrillation (AF) patients at high bleeding risk. The combined procedure was safe and effective, achieving LAA closure and maintaining sinus rhythm without complications.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrial fibrillation (AF) is a primary cause of cardioembolic stroke.
- Left atrial appendage (LAA) closure is an alternative for high-bleeding-risk patients unsuitable for long-term anticoagulation.
- Epicardial LAA occlusion and endo-epicardial ablation can reduce AF recurrence.
Purpose of the Study:
- To evaluate the feasibility and safety of a combined LAA ligation and endo-epicardial ablation procedure.
- To assess the efficacy of this hybrid approach in patients with refractory AF and contraindications to anticoagulation.
Main Methods:
- A case series of 5 patients with refractory AF and high bleeding risk undergoing combined LAA ligation and endo-epicardial ablation.
- LAA closure was performed epicardially using the LARIAT system, followed by endocardial and epicardial ablation.
- Short-term anticoagulation was administered post-procedure.
Main Results:
- All procedures were completed without complications.
- Transesophageal echocardiography confirmed complete LAA occlusion in all patients at follow-up.
- Patients remained asymptomatic, in sinus rhythm, with no reported hemorrhage or ischemic events.
Conclusions:
- The combined percutaneous LAA ligation and endo-epicardial ablation is a feasible and safe approach.
- This hybrid technique may offer a novel treatment option for refractory AF patients requiring LAA occlusion.
Introduction:
Atrial fibrillation (AF) is the main cause of cardioembolic stroke. In high-bleeding-risk patients, long-life anticoagulation therapy is not permitted, and left atrial appendage (LAA) closure may be considered. LAA is also a critical substrate for AF. Epicardial LAA occlusion has several advantages: LAA ligation results in a favorable electrical and structural atrial remodeling, which decreases AF recurrence. Endocardial ablation alone is not efficient for all patients, and new evidence shows better outcomes in patients affected by persistent AF after a combined hybrid endo-epicardial ablation. Considering the synergic potential of these techniques, in this case series, they were both combined in a single procedure.
Methods And Results:
We describe the treatment of 5 patients referred for refractory AF ablation and LAA closure. All patients had high thrombotic and previous major hemorrhage, with relative contraindication to life-long therapy with anticoagulation. A combined procedure of LAA ligation and endo-epicardial ablation was scheduled with short-term anticoagulation. LAA closure was performed with an epicardial approach using the LARIAT system. Then, LA mapping and ablation were performed, endocardially and then epicardially.All procedures were concluded without complications.At follow-up, in all patients, transesophageal echocardiography showed the complete occlusion of the LAA; therefore, anticoagulation therapy was interrupted. All patients were asymptomatic, and in the sinus rhythm, no hemorrhage or ischemic events occurred.
Conclusion:
The combination of percutaneous LAA ligation and endo-epicardial ablation was revealed to be feasible and safe and might represent a new approach for the treatment of refractory AF in patients with indication of LAA occlusion.
