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Updated: Jan 7, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage closure: Current status, unresolved issues, and future perspectives
Yusuke Kondo1, Satoko Ryuzaki2, Miyo Nakano3
1Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 260-8670, 1-8-1 Inohana, Chuo-ku, Japan. simokita9933@msn.com.
Insights
Left atrial appendage closure (LAAC) offers stroke prevention for nonvalvular atrial fibrillation (AF) patients unable to use oral anticoagulation (OAC). Ongoing research focuses on optimizing device safety, reducing complications like device-related thrombus, and expanding LAAC indications.
Area of Science:
- Cardiology
- Medical Devices
- Stroke Prevention
Background:
- Left atrial appendage closure (LAAC) is a key stroke prevention therapy for nonvalvular atrial fibrillation (AF) patients contraindicated for oral anticoagulation (OAC).
- LAAC adoption is increasing in Japan, exceeding 10,000 procedures.
- Current indications are restricted to high-risk patients.
Purpose of the Study:
- To review the current status, challenges, and future directions of LAAC, focusing on the WATCHMAN device.
- To discuss advancements in LAAC devices and imaging techniques.
- To explore future priorities for expanding LAAC use and improving patient outcomes.
Main Methods:
- Review of clinical trials and registries evaluating LAAC devices (WATCHMAN FLX, FLX Pro, Amulet).
- Analysis of safety and efficacy data compared to oral anticoagulation.
- Evaluation of emerging technologies like intracardiac echocardiography (ICE) and pulsed field ablation (PFA).
Main Results:
- LAAC demonstrates stroke prevention efficacy comparable to OAC with a lower risk of bleeding.
- WATCHMAN FLX/FLX Pro show improved safety and adaptability.
- Device-related thrombus (DRT) and peri-device leak (PDL) remain significant concerns requiring optimized antithrombotic therapy.
- Amulet offers superior sealing but has higher complication rates.
- ICE enables less invasive procedures and same-session AF ablation.
Conclusions:
- LAAC is an effective stroke prevention strategy for selected AF patients.
- Addressing DRT and PDL is crucial for long-term success.
- Technological advancements like ICE and PFA are enhancing procedural efficiency and enabling integrated approaches.
- Future research should focus on risk stratification, personalized antithrombotic regimens, and broadening LAAC indications.
Abstract:
Left atrial appendage closure (LAAC) is an established therapy for stroke prevention in patients with nonvalvular atrial fibrillation (AF) who cannot tolerate long-term oral anticoagulation (OAC). In Japan, LAAC was introduced in 2019 and has been performed in more than 10,000 cases a0s of 2025. Although indications remain limited to high-risk patients with OAC contraindications, procedural volume continues to rise. This review outlines the current status, remaining challenges, and future perspectives of LAAC, with emphasis on the WATCHMAN device. The WATCHMAN FLX and FLX Pro have enhanced procedural safety, sealing efficacy, and anatomical adaptability. Large clinical trials and registries have confirmed stroke prevention efficacy comparable to OAC with fewer hemorrhagic complications. However, device-related thrombus (DRT) and peri-device leak (PDL) remain major concerns, underscoring the need to optimize postprocedural antithrombotic therapy. The Amulet device provides superior ostial sealing through its dual-disk design but is technically more complex and associated with higher procedural complication rates. Intracardiac echocardiography (ICE) has emerged as a less invasive alternative to transesophageal echocardiography, reducing anesthesia requirements and enabling same-session LAAC with AF ablation. The development of pulsed field ablation (PFA) further improves the feasibility of such integrated approaches. Future priorities include risk stratification for DRT, individualized antithrombotic strategies, and broader indications encompassing OAC-resistant embolic stroke and other high-risk populations. With advancing technology, ICE-guided, minimally invasive workflows and integrated ablation-occlusion procedures are expected to establish LAAC as a key component of comprehensive AF management.
