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Updated: Jan 14, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Stroke prevention in nonvalvular atrial fibrillation: Thoracoscopic left atrial appendage closure with or without
Hiroshi Ito1, Hiroshi Kurazumi2, Soichi Ike1
1Department of Cardiovascular Surgery, Saiseikai Shimonoseki General Hospital, Shimonoseki, Yamaguchi, Japan.
Insights
Totally thoracoscopic left atrial appendage closure (TT-LAAC) effectively prevents stroke in atrial fibrillation (AF) patients. Procedures, with or without the MAZE procedure, offer a safe and valuable treatment strategy for AF management.
Area of Science:
- Cardiology
- Thoracic Surgery
Background:
- Atrial fibrillation (AF) poses a significant risk of cardioembolic events.
- Left atrial appendage closure (LAAC) is a strategy to mitigate this risk.
- Totally thoracoscopic LAAC (TT-LAAC) offers a minimally invasive approach.
Purpose of the Study:
- To evaluate outcomes of TT-LAAC with and without the MAZE procedure.
- To assess the efficacy of TT-LAAC in preventing cardioembolic events.
- To determine the impact on rhythm control in AF patients.
Main Methods:
- 200 patients underwent TT-LAAC (n=49) or TT-MAZE (n=151).
- Procedures performed thoracoscopically with radiofrequency ablation.
- Successful closure defined as LAA stump <10 mm.
Main Results:
- Successful LAA closure in all patients.
- No in-hospital mortality or postoperative strokes observed.
- 96.5% discontinued anticoagulation by 3 months.
- 72% maintained sinus rhythm at 4 years in the TT-MAZE group.
Conclusions:
- TT-LAAC is effective in preventing cardioembolic stroke in AF patients.
- The procedure is valuable regardless of sinus rhythm restoration.
- TT-LAAC, with or without MAZE, is a safe and effective AF treatment.
Objectives:
Totally thoracoscopic left atrial appendage closure (TT-LAAC) with or without the MAZE procedure is an LAA management technique that prevents cardioembolic events by closing the LAA in patients with atrial fibrillation (AF). Additionally, it facilitates rhythm control with a concurrent a mini-maze procedure. Here we present TT-LAAC outcomes without the MAZE procedure (TT-LAAC) and with the maze procedure (TT-MAZE).
Methods:
LAAC and/or bilateral pulmonary vein isolation were performed under complete thoracoscopy, with ablation performed using a radiofrequency device. Patients undergoing both LAAC and ablation were classified as TT-MAZE, whereas those undergoing only closure were classified as TT-LAAC. Successful closure was defined as a stump <10 mm as assessed via intraoperative transesophageal echocardiography.
Results:
Between March 2018 and January 2025, 200 patients (155 males, 45 females; mean age, 70.4 ± 9.6 years) underwent TT-MAZE (n = 151) or TT-LAAC (n = 49). AF subtypes included paroxysmal in 62 patients, persistent in 105 patients, and permanent in 33 patients. Closure of the LAA was successful in all patients. No in-hospital mortality was observed. Anticoagulant therapy was discontinued in 96.5% of the patients (n = 193) of patients after 3 months. No postoperative strokes were observed during the mean follow-up of 3 years. In the TT-MAZE group, sinus rhythm was maintained in 72% of patients at 4 years postoperatively.
Conclusions:
TT-LAAC procedures effectively prevent cardioembolic stroke even after discontinuation of anticoagulant therapy, regardless of whether sinus rhythm was restored after surgery. These procedures remain a valuable treatment strategy for AF.
