Related Experiment Video
Updated: May 20, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Multicenter Experience of Percutaneous Left Atrial Appendage Occlusion in Current Indications and Different
Shu-I Lin1,2,3, Chun-Yen Chen1,2, Wei-Ta Chen4,5
1Cardiovascular Center, MacKay Memorial Hospital, Taipei.
Insights
Left atrial appendage closure effectively reduces stroke risk in atrial fibrillation patients with suboptimal anticoagulation. This procedure is safe and feasible, even with high-flow nasal cannula oxygen therapy, showing comparable outcomes to traditional anesthesia.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Atrial fibrillation (AF) poses a significant stroke risk, even with oral anticoagulants.
- Left atrial appendage (LAA) closure offers an alternative for patients with suboptimal pharmacological therapy.
- Suboptimal therapy includes anticoagulant intolerance and inadequacy.
Purpose of the Study:
- To evaluate the feasibility, safety, and outcomes of LAA occlusion procedures.
- To compare outcomes for two distinct indications: anticoagulant intolerance and inadequacy.
- To compare short-term outcomes between two anesthesia methods: high-flow nasal cannula oxygen therapy and intubated general anesthesia.
Main Methods:
- Retrospective multicenter study of 75 patients undergoing LAA closure (September 2017 - June 2021).
- Patients categorized by indication: anticoagulant inadequacy (n=19) or intolerance (n=56).
- One-year outcomes analyzed; short-term outcomes compared between anesthesia groups.
Main Results:
- LAA occlusion was effective in reducing stroke risk for patients with suboptimal therapy.
- No significant outcome differences observed between the two indication groups.
- LAA closure under high-flow nasal cannula oxygen therapy was feasible, safe, and comparable to intubated anesthesia.
Conclusions:
- LAA occlusion is effective and safe for approved indications in Taiwan, with consistent 1-year outcomes.
- High-flow nasal cannula oxygen therapy is a feasible and comparable alternative to intubated anesthesia for LAA closure.
- Further large-scale randomized trials with extended follow-up are warranted.
Background:
Stroke remains a concern in patients with atrial fibrillation despite the efficacy of oral anticoagulants. Left atrial appendage closure has emerged as a treatment option for patients with suboptimal pharmacological therapy.
Objectives:
This retrospective multicenter study aimed to evaluate the feasibility, safety, and outcomes of left atrial appendage occlusion procedures for two different indications. Short-term outcomes between two different methods of general anesthesia during the procedures were also compared.
Methods:
The study included patients who underwent appendage closure between September 2017 and June 2021. Two indications for the procedures, anticoagulant intolerance, and anticoagulant inadequacy were recorded. One-year outcomes were analyzed between groups. Short-term outcomes were compared between the intravenous general anesthesia with high-flow nasal cannula oxygen therapy and intubated general anesthesia groups.
Results:
A total of 75 consecutive patients were enrolled: 19 patients in the anticoagulant inadequacy group and 56 in the anticoagulant intolerance group. Appendage occlusion was effective in reducing stroke risk in atrial fibrillation patients with suboptimal pharmacological therapy. There were no significant differences in outcomes between the two indication groups. Appendage closure under high-flow nasal cannula oxygen therapy was found to be feasible and safe, with comparable results to intubated general anesthesia.
Conclusions:
Appendage occlusion is effective and safe for Taiwan National Health Insurance-approved indications, with no difference between indication groups during 1-year of follow-up. Appendage occlusion under high-flow nasal cannula oxygen therapy is feasible and comparable to intubated general anesthesia. Larger randomized studies with longer follow-up are needed to confirm these findings.
