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Updated: Jan 12, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Robot-Assisted Minimally Invasive Strategy for a Large Mobile Thrombus Originating From the Left Atrial Appendage
Ryo Otake1, Gentaku Hama2, Yuhei Kasai1
1Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan.
Background:
Large, mobile thrombus in the left atrial appendage (LAA) carries an urgent risk of systemic embolization. Management is challenging when anticoagulation or open surgery is unsuitable in elderly or frail patients.
Case Summary:
A 78-year-old woman with prior atrial fibrillation ablation was detected a large mobile LAA thrombus on surveillance imaging after self-discontinuing apixaban. Anticoagulation and systemic thrombolysis carried a high embolic risk, open surgery was unsuitable due to age and frailty, and percutaneous closure was contraindicated. Urgent robot-assisted en bloc thrombectomy with internal LAA closure via right mini-thoracotomy achieved complete exclusion. She was discharged on postoperative day 5 without complications.
Discussion:
Robot-assisted cardiac surgery enables definitive thrombus removal and secure LAA closure in selected high-risk patients, offering a minimally invasive alternative to sternotomy.
Take-Home Message:
In elderly, frail patients with large, mobile LAA thrombus, robot-assisted minimally invasive surgery is a safe, effective alternative when conventional strategies are unsuitable.
