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Updated: Jul 14, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Overcoming barriers for left atrial appendage thrombus: a systematic review of left atrial appendage closure
Zixi Zhang1, Jiabao Zhou1, Qiuzhen Lin1
1Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Hunan Province, Changsha, 410011, People's Republic of China.
Insights
Left atrial appendage closure (LAAC) shows preliminary safety and effectiveness for patients with left atrial appendage thrombus (LAAT), despite contraindications. Further large-scale trials are needed to confirm these findings for clinical practice.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Left atrial appendage thrombus (LAAT) is a common complication in non-valvular atrial fibrillation, persisting in 8% of patients despite anticoagulation.
- Current guidelines contraindicate left atrial appendage closure (LAAC) for patients with LAAT.
- The safety and feasibility of LAAC in this patient group remain underexplored.
Conclusions:
- LAAC demonstrates preliminary effectiveness and safety in patients with persistent LAAT.
- Further large-scale randomized controlled trials (RCTs) are necessary.
- Future research should investigate varied LAAT characteristics and LAAC device types for evidence-based clinical decision-making.
Background:
Approximately 90% of intracardial thrombi originate from the left atrial appendage in non-valvular atrial fibrillation patients. Even with anticoagulant therapy, left atrial appendage thrombus (LAAT) still occurs in 8% of patients. While left atrial appendage closure (LAAC) could be a promising alternative, the current consensus considers LAAT a contraindication to LAAC. However, the feasibility and safety of LAAC in patients with LAAT have yet to be determined.
Methods:
This systematic review synthesizes published data to explore the feasibility and safety of LAAC for patients with LAAT.
Results:
This study included a total of 136 patients with LAATs who underwent successful LAAC. The Amulet Amplatzer device was the most frequently utilized device (48.5%). Among these patients, 77 (56.6%) had absolute contraindications to anticoagulation therapy. Cerebral protection devices were utilized by 47 patients (34.6%). Transesophageal echocardiography (TEE) is the primary imaging technique used during the procedure. Warfarin and novel oral anticoagulants were the main anticoagulant medications used prior to the procedure, while dual antiplatelet therapy was primarily used post-procedure. During a mean follow-up period of 13.2 ± 11.5 months, there was 1 case of fatality, 1 case of stroke, 3 major bleeding events, 3 instances of device-related thrombus, and 8 cases of peri-device leakage.
Conclusions:
This review highlights the preliminary effectiveness and safety of the LAAC procedure in patients with persistent LAAT. Future large-scale RCTs with varied LAAT characteristics and LAAC device types are essential for evidence-based decision-making in clinical practice.
