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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
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Clinical management after surgical left atrial appendage exclusion
Prashant D Bhave1,2, Karanpreet K Dhaliwal3, Sneha Chebrolu4
1Department of Internal Medicine, Section on Cardiovascular Medicine, School of Medicine, Wake Forest University, Winston-Salem, NC, USA. pdbhave@gmail.com.
Journal of Cardiothoracic Surgery
|March 18, 2025
Summary
Management of oral anticoagulation after surgical left atrial appendage (LAA) closure is inconsistent. Successful LAA exclusion via TEE increases the likelihood of discontinuing anticoagulation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Stroke Prevention
Background:
- Surgical left atrial appendage (LAA) closure is a growing strategy for stroke risk reduction in atrial fibrillation (AF).
- Optimal post-operative anticoagulation management following surgical LAA closure remains unclear.
Purpose of the Study:
- To investigate the real-world clinical practices for anticoagulation in patients who have undergone surgical LAA management.
- To assess factors influencing anticoagulation decisions after LAA closure.
Main Methods:
- Retrospective chart review of 458 patients with AF who underwent surgical LAA exclusion during cardiac surgery over 7 years.
- Median follow-up of 2 years; successful LAA ligation defined by transesophageal echocardiography (TEE).
Main Results:
- 299 patients were discharged on oral anticoagulation (OAC); 31% had follow-up TEE.
- 59% of patients with TEE and 32% without TEE were taken off OAC.
- Among those with successful LAA exclusion confirmed by TEE, 67% discontinued OAC, with cessation typically occurring post-TEE.
Conclusions:
- Clinical management of oral anticoagulation and LAA imaging after surgical LAA management is highly variable.
- Further standardization of post-procedural care is warranted.
