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Updated: Sep 9, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing
D Gonzalez-Calle1, L Nombela-Franco2, H Gutierrez-Garcia3
1Hospital Universitario de Salamanca, CIBERCV, IBSAL, Spain.
Insights
Left atrial appendage occlusion (LAAO) is a safe and effective alternative to oral anticoagulation for patients with atrial fibrillation and prior intracranial hemorrhage. Early versus late LAAO showed similar safety and efficacy outcomes.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Oral anticoagulation (OAC) increases intracranial hemorrhage (ICH) risk in atrial fibrillation (AF) patients.
- Left atrial appendage occlusion (LAAO) offers an alternative to OAC, but data in prior ICH patients is limited.
- The optimal timing for LAAO in patients with prior ICH remains controversial, with limited long-term outcome data.
Purpose of the Study:
- To assess the safety and efficacy of LAAO in non-valvular AF patients with a history of ICH.
- To determine the appropriate timing for performing LAAO after ICH.
- To evaluate long-term outcomes following LAAO in this high-risk patient population.
Main Methods:
- A multicenter retrospective registry of 128 patients with AF and prior ICH undergoing LAAO.
- Patients were stratified into early occlusion (before 90 days post-ICH, n=31) and late occlusion (after 90 days post-ICH, n=97) groups.
- Comparison of procedural success, complications, and long-term clinical outcomes (ischemic and bleeding events, mortality).
Main Results:
- High procedural success rate (97%) with low complication rates (3.15%).
- Significant reduction in expected ischemic and bleeding rates post-LAAO.
- No significant differences in baseline characteristics, procedural outcomes, or long-term mortality, ischemic events, or hemorrhage between early and late occlusion groups.
Conclusions:
- LAAO is a safe and effective treatment for reducing ischemic stroke risk in AF patients with prior ICH.
- Early LAAO (before 90 days) demonstrated comparable safety and efficacy to late LAAO.
- Further research is warranted to support early LAAO to mitigate risks associated with oral anticoagulation withdrawal.
Background:
Oral anticoagulation (OAC) use increases the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) and CHA2DS2-VASc ≥2. Left atrial appendage occlusion (LAAO) is an alternative to OAC, however data about its use in patients with prior ICH is scarce and the timing of its performance is controversial. Furthermore, the long-term outcomes in this group of patients have not been described previously.
Objective:
To evaluate the safety and efficacy of LAAO in patients with non-valvular AF and prior ICH (CHA2DS2-VASc ≥2) and to determine adequate timing of its performance.
Methods:
This is a multicenter retrospective registry that included 128 patients, whose indication for this procedure was ICH. Patients were divided into two groups: early occlusion (n=31; 24.2%), in which the procedure was performed before 90 days had elapsed after the bleeding, and late occlusion (n=97; 75.8%), after 90 days.
Results:
Global procedural success was of 97% (124/128). Procedure-related complications occurred in 4 patients (3.15%): 2 cardiac tamponade, 1 device embolization and 1 transient ischemic attack during hospitalization. There was a significant reduction in the ischemic and bleeding rates compared to expected based on CHA2DS2-VASc and HASBLED scores (93.9% and 89.9% respectively) after a mean follow-up of 73.9±34.1 months. There were no significant differences neither in baseline characteristics between the early and late occlusion groups nor in the procedural success or complications rates. Furthermore, no statistically significant differences were found in mortality, ischemic events, or hemorrhage between the early and late occlusion group.
Conclusions:
Left atrial appendage occlusion is an effective and safe treatment alternative to reduce the risk of ischemic stroke in selected patients with atrial fibrillation and prior intracranial hemorrhage. In this study, we did not find differences regarding safety and efficacy in early closure compared with late closure. Further studies are needed to support early closure to reduce the complications associated with oral anticoagulation withdrawal.
