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Updated: Sep 20, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
[Surgical closure of the left atrial appendage for thromboembolism prophylaxis]
Ioana Geisler1, Thomas Pühler2, Stephan Ensminger2
1Klinik für Herz- und thorakale Gefäßchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. ioana.geisler@uksh.de.
Insights
Surgical left atrial appendage (LAA) closure is established for atrial fibrillation (AF) patients undergoing cardiac surgery, reducing thromboembolism. Ongoing trials explore its use in high-stroke-risk patients with sinus rhythm.
Area of Science:
- Cardiology
- Vascular Surgery
- Thrombosis Research
Context:
- The left atrial appendage (LAA) is a primary source of thrombi in patients with atrial fibrillation (AF).
- Current guidelines advocate surgical LAA closure during cardiac surgery or ablation for AF.
- Various surgical techniques exist for LAA occlusion.
Purpose:
- To review current evidence on surgical LAA closure.
- To discuss indications, techniques, and clinical outcomes.
- To provide an outlook on the future role of LAA closure.
Summary:
- Surgical LAA closure is recommended for AF patients undergoing cardiac surgery or ablation.
- A large randomized study demonstrated reduced thromboembolism with surgical LAA closure in AF patients.
- Ongoing research investigates LAA closure for stroke risk reduction in sinus rhythm patients.
Impact:
- Established role of surgical LAA closure in AF patients undergoing cardiac surgery.
- Uncertainty remains regarding anticoagulation needs post-successful LAA closure.
- Future research will clarify the prophylactic role of LAA closure in high-stroke-risk sinus rhythm patients.
Background:
The left atrial appendage (LAA) is the origin of thrombi in patients with atrial fibrillation (AF). Various techniques are available for surgical LAA occlusion. Current guidelines recommend surgical LAA closure as concomitant procedure in patients undergoing cardiac surgery or endoscopic or hybrid ablation for AF.
Objectives:
This review article summarizes the current scientific evidence regarding surgical LAA closure and provides an outlook into its potential role in the future.
Materials And Methods:
A literature review was performed for LAA closure, indications, techniques, clinical outcomes, and ongoing studies.
Results:
Different techniques are performed for surgical LAA closure. In a large randomizes study surgical LAA closure was associated with a reduction in thromboembolism in patients with AF. There are ongoing studies that examine the potential role of surgical LAA closure in patients with sinus rhythm and increased risk for stroke.
Conclusions:
Surgical closure as a concomitant procedure in patients with AF undergoing cardiac surgery is now well established. It is unclear whether these patients require anticoagulation after successful closure. Currently, a few randomized trials are ongoing to evaluate whether prophylactic surgical LAA closure in patients with sinus rhythm and increased risk for stroke effectively reduces the incidence of stroke. At present, there are no data that support surgical LAA closure in patients with sinus rhythm and low risk for stroke.
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