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Updated: Jul 23, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and
Mariusz Kowalewski1,2,3,4, Michał Święczkowski5, Łukasz Kuźma4,5
1Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland.
Insights
Left atrial appendage closure (LAAC) concomitant to heart surgery reduces stroke risk and possibly mortality in patients with atrial fibrillation (AF). Benefits were not observed in patients without AF, indicating tailored treatment approaches are necessary.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Left atrial appendage closure (LAAC) concomitant to heart surgery is increasingly considered for patients with atrial fibrillation (AF) to reduce thromboembolic complications.
- Existing data on mortality benefits in non-AF patients undergoing concomitant LAAC are conflicting, necessitating further investigation.
Purpose of the Study:
- To evaluate the efficacy of concomitant LAAC versus no LAAC in reducing all-cause mortality and stroke risk in patients undergoing heart surgery.
- To determine if the benefits of concomitant LAAC differ between patients with and without preoperative atrial fibrillation.
Main Methods:
- A systematic review and meta-analysis of studies comparing concomitant LAAC with no LAAC in patients undergoing heart surgery.
- Assessment of early and long-term all-cause mortality and stroke rates.
- Subgroup analyses were performed based on the presence or absence of preoperative AF.
Main Results:
- Concomitant LAAC was associated with reduced long-term mortality (RR, 0.86; 95% CI, 0.74-1.00) and significantly reduced early (RR, 0.81; 95% CI, 0.72-0.93) and late stroke risk (RR, 0.87; 95% CI, 0.84-0.90) in the overall population.
- Subgroup analysis revealed that these benefits, including a trend towards lower mortality (RR, 0.85; 95% CI, 0.72-1.01), were significant only in patients with preoperative AF.
- No significant benefits in mortality or stroke reduction were observed in patients without preoperative AF.
Conclusions:
- Concomitant LAAC in heart surgery is associated with reduced stroke rates and potentially reduced long-term mortality, but these benefits are primarily observed in patients with preoperative atrial fibrillation.
- Routine concomitant LAAC in patients without AF undergoing heart surgery is not supported by current evidence.
- Further research is warranted to clarify the role of LAAC in non-AF patients and to optimize patient selection for concomitant procedures.
Objective:
Left atrial appendage closure (LAAC) concomitant to heart surgery in patients with underlying atrial fibrillation (AF) has gained attention because of long-term reduction of thromboembolic complications. As of mortality benefits in the setting of non-AF, data from both observational studies and randomized controlled trials are conflicting.
Methods:
On-line databases were screened for studies comparing LAAC versus no LAAC concomitant to other heart surgery. End points assessed were all-cause mortality and stroke at early and longest-available follow-up. Subgroup analyses stratified on preoperative AF were performed. Risk ratios (RR) with 95% CIs served as primary statistics.
Results:
Electronic search yielded 25 studies (N = 660 [158 patients]). There was no difference between LAAC and no LAAC in terms of early mortality. In the overall population analysis, LAAC reduced long-term mortality (RR, 0.86; 95% CI, 0.74-1.00; P = .05; I 2 = 88%), reduced early stroke risk by 19% (RR, 0.81; 95% CI, 0.72-0.93; P = .002; I 2 = 57%), and reduced late stroke risk by 13% (RR, 0.87; 95% CI, 0.84-0.90; P < .001; I 2 = 58%). Subgroup analysis showed lower mortality (RR, 0.85; 95% CI, 0.72-1.01; P = .06; I 2 = 91%), short-, and long-term stroke risk reduction only in patients with preoperative AF (RR, 0.81; 95% CI, 0.71-0.93; P = .003; I 2 = 71% and RR, 0.87; 95% CI, 0.84-0.91; P < .001; I 2 = 70%, respectively). No benefit of LAAC in patients without AF was found.
Conclusions:
Concomitant LAAC was associated with reduced stroke rates at early and long-term and possibly reduced all-cause mortality at the long-term follow-up but the benefits were limited to patients with preoperative AF. There is not enough evidence to support routine concomitant LAAC in non-AF settings.
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