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Updated: Sep 13, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Simultaneous Endocardial and Epicardial Approach for Successful Closure of Left Atrial Appendage With Difficult
Aashish Katapadi1, Rakesh Gopinathannair1, Naga Venkata K Pothineni1
1Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA.
Background:
Left atrial appendage closure (LAAC) is increasingly used for stroke prevention; however, left atrial appendage (LAA) anatomy may pose significant challenges.
Case Summary:
A 67-year-old man with paroxysmal atrial fibrillation, CHA2DS2-VASc Score of 3, and recurrent falls was referred for LAAC. Owing to challenging anatomy noted during preoperative imaging, epicardial access was obtained at procedure onset. Following multiple unsuccessful endocardial attempts, LAAC was successfully achieved by an epicardial device.
Discussion:
Preprocedural imaging can identify challenging LAA anatomy and assist in procedural planning. In patients with challenging LAA anatomy, obtaining epicardial access up front before endocardial closure attempts offers an additional immediate option in case of failure. This case highlights the importance and use of both endocardial and epicardial LAAC strategies for a comprehensive LAAC program.
Take-Home Message:
We demonstrate that a methodological approach with preprocedural LAA imaging and endocardial and epicardial LAAC strategies results in successful clinical outcomes.
