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Updated: May 11, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Speech bubble sign - insights regarding incomplete left atrial appendage closure via electrocardiography-synchronized
Taisuke Nakayama1, Yoshitsugu Nakamura1, Atsushi Shukuya2
1Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Chiba, Japan.
Objectives:
In atrial fibrillation (AF), surgical management of the left atrial appendage (LAA) is crucial to prevent stroke. However, incomplete closure poses a residual embolic risk.
Methods:
We retrospectively analyzed patients who underwent LAA closure using a continuous polypropylene suture technique during mitral valve surgery with the da Vinci system. Closure completeness was assessed via electrocardiogram-gated computed tomography (CT), and 3 D imaging was used to localize incomplete sites.
Results:
Of 125 patients, 100 underwent postoperative CT. Complete closure (cLAA) was achieved in 76%, while 24% had incomplete closure (iLAA), typically at the mitral valve junction or suture start. These showed a characteristic "speech bubble" appearance. iLAA was associated with tricuspid valve repair and low V1 f-wave amplitude. Stroke rates were similar between groups over 24 months.
Conclusions:
Incomplete LAA closure occurred in 24% of cases despite direct visualization using robotics. Anatomical factors likely contribute more than technique alone. For high-risk patients with long-standing AF, techniques such as lumen crushing or external clips may enhance closure success. Further refinements are needed to improve the reliability of internal LAA closure methods.
