Related Experiment Video
Updated: May 7, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Catheter ablation for atrial fibrillation in patients with prior left atrial appendage occlusion device
Jakrin Kewcharoen1, Kuldeep Shah2, Rahul Bhardwaj1
1Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA.
Insights
Catheter ablation (CA) for atrial fibrillation (AF) in patients with left atrial appendage occlusion (LAAO) devices is safe and feasible. This study found favorable outcomes, with no stroke or device complications, demonstrating CA as a viable option post-LAAO.
Area of Science:
- Cardiovascular Medicine
- Electrophysiology
- Medical Devices
Background:
- Limited data exists on the safety and efficacy of catheter ablation (CA) for atrial arrhythmias (AA) in patients who have undergone left atrial appendage occlusion (LAAO).
- Patients with LAAO devices often have significant comorbidities, increasing the complexity of managing coexisting atrial fibrillation (AF) or other atrial arrhythmias.
Purpose of the Study:
- To evaluate the feasibility and safety of catheter ablation (CA) for atrial fibrillation (AF) and left-sided atrial arrhythmias (AA) in patients with existing left atrial appendage occlusion (LAAO) devices.
- To assess primary outcomes including procedure-related complications, device-related complications, AA recurrence, and stroke incidence in this specific patient population.
Main Methods:
- A single-center retrospective registry analysis included patients with prior LAAO devices who underwent catheter ablation for AF or left-sided AA between January 2020 and January 2023.
- Data collection focused on procedure- and device-related complications, AA recurrence rates, and stroke occurrence.
- Specific ablation techniques, including those near the LAA ostium and Vein of Marshall alcohol ablation, were noted.
Main Results:
- Thirty patients with prior LAAO were analyzed; 93.3% underwent ablation for AF. Peri-procedural complications occurred in 10% (n=3), none related to the LAAO device.
- During a mean follow-up of 440 days, 40% experienced AA recurrence, primarily AF. No strokes or device-related complications (e.g., leaks, thrombosis) were observed in patients with follow-up imaging.
- 16.7% underwent ablation near the LAA ostium, and one patient had Vein of Marshall alcohol ablation.
Conclusions:
- Catheter ablation for AF, including Vein of Marshall alcohol ablation, is a feasible and safe procedure in patients with prior LAAO devices.
- The study demonstrates favorable outcomes, supporting CA as a viable therapeutic option for managing atrial arrhythmias in patients with LAAO devices.
Background:
The safety and efficacy of CA for AF and left-sided atrial arrhythmias (AA) in patients with left atrial appendage occlusion (LAAO) devices are lacking.
Methods:
This is a single-center retrospective registry that included all patients with prior LAAO who underwent catheter ablation for AF or left-sided atrial arrhythmia from January 2020-January 2023. The primary outcomes were procedure-related complications, device-related complications, AA recurrence, and stroke.
Results:
A total of 30 patients with prior LAAO were included in the analysis (mean age 75.1 ± 7.1 years old, 50% male, mean CHA2DS2-VASc score 4 ± 1.6, 46.7% paroxysmal AF, 73.3% had prior AF ablation, mean time to ablation 475 ± 365 days). 93.3% (n = 28) and 6.6% (n = 2) patients had ablation for AF (46.7% paroxysmal, 36.7% persistent, 10% long-standing persistent) and left-sided atrial tachycardia, respectively. 16.7% (n = 5) patients underwent ablation along the left atrial appendage ostium, and 3.3% (n = 1) underwent Vein of Marshall alcohol ablation. There were 3 (10%) peri-procedural complications (1 access hematoma and two pericardial effusions requiring intervention-none related to left atrial appendage ostium or alcohol ablation). During the mean follow-up of 440 ± 379 days, 40% (n = 12) patients had AA recurrence (91.6% AF, 8.3% atrial tachycardia), of which five patients needed repeat ablation, and two patients were readmitted for heart failure. There was no stroke or any device-related complications, including new peri-device leaks or device-related thrombosis in patients who had follow-up imaging studies (n = 11, 36.7%).
Conclusion:
Catheter ablation for AF (including VoM alcohol ablation) in patients with prior LAAO devices is feasible and safe with favorable outcomes.
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:21Cardiac Catheterization II: Right Heart Catheterization
01:24Cardiac Catheterization III: Left Heart Catheterization