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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

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Percutaneous Left Atrial Appendage Closure: Current Evidence and Procedural Insights.

Mohsen Mohandes¹, Leydimar Anmad Shihadeh², Alberto Pernigotti¹

¹Interventional Cardiology Unit, Cardiology Division, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain.

Reviews in Cardiovascular Medicine

|January 12, 2026

Summary

Left atrial appendage closure (LAAC) offers a device-based alternative to oral anticoagulation for stroke prevention in atrial fibrillation (AF) patients. This review details the LAAC procedure and its expanding role in managing AF-related stroke risks.

Keywords:

atrial fibrillation (AF)cardiac computed tomography (CCT)direct oral anticoagulant (DOAC)left atrial appendage closure (LAAC)oral anticoagulation (OAC)transesophageal echocardiography (TEE)transseptal puncture (TSP)vitamin K antagonist (VKA)

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Area of Science:

Cardiology
Interventional Cardiology
Medical Devices

Background:

Atrial fibrillation (AF) is a leading cause of cardioembolic stroke, with the left atrial appendage (LAA) as the primary thrombus site.
Oral anticoagulation (OAC) is standard for stroke prevention but has contraindications and bleeding risks.
Percutaneous left atrial appendage closure (LAAC) is an emerging device-based alternative to OAC.

Purpose of the Study:

To review current evidence on LAAC procedures.
To provide a procedural roadmap for LAAC.
To discuss expanding indications and future research directions for LAAC.

Main Methods:

Review of current evidence on LAAC.
Step-by-step procedural guide from imaging to device release.
Discussion of imaging modalities, device selection, and post-procedural strategies.

Main Results:

LAAC is an effective device-based alternative for stroke prevention in AF.
Advances in imaging and technology improve LAAC efficacy and safety.
Indications for LAAC are expanding to include complex patient groups.

Conclusions:

LAAC is a valuable option for stroke prevention in AF patients unsuitable for OAC.
Ongoing research aims to optimize post-LAAC antithrombotic strategies and patient selection.
LAAC's role in AF management is evolving with technological and clinical advancements.