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Updated: Aug 5, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Unsuccessful percutaneous left atrial appendage occlusion: A single center perspective
Adnan Ahmed1, Rachad Ghazal2, Aashish Katapadi1
1Department of Cardiology, HCA Midwest, Overland Park, KS, USA.
Insights
Left atrial appendage occlusion (LAAO) has a low failure rate for stroke prevention in atrial fibrillation patients. Unsuccessful device implantation (UDI) occurred in 4.9%, with LAA morphology impacting success.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Left atrial appendage occlusion (LAAO) is a key stroke prevention strategy for atrial fibrillation (AF) patients unable to use oral anticoagulants.
- Limited data exists on the outcomes of failed LAAO procedures, necessitating further investigation.
Purpose of the Study:
- To determine the incidence and outcomes of unsuccessful left atrial appendage occlusion (LAAO) procedures.
- To identify factors contributing to LAAO device implantation failure.
Main Methods:
- A retrospective analysis of 411 patients undergoing LAAO between 2020 and 2023.
- Primary endpoint defined as unsuccessful device implantation (UDI), with device types including Lariat, Amulet, and Watchman FLX/FLX Pro.
Main Results:
- The overall UDI rate was 4.9%, with the Lariat device showing the highest rate (17.9%).
- Reasons for UDI included poor device positioning, inadequate depth, anatomical issues, and trabeculations.
- 40% of patients with UDI proceeded to AtriClip surgical exclusion; others continued oral anticoagulation.
Conclusions:
- Left atrial appendage occlusion (LAAO) is a safe procedure with a low failure rate.
- Left atrial appendage morphology is a critical factor influencing LAAO success.
- AtriClip surgical exclusion is a viable alternative following unsuccessful LAAO device implantation.
Background:
Epicardial and endocardial left atrial appendage occlusion (LAAO) is commonly performed for stroke prevention for atrial fibrillation (AF) patients at increased risk for stroke who cannot tolerate long-term oral anticoagulation. However, there is limited data on the outcomes of unsuccessful LAAO procedures. This study aims to assess the incidence and outcomes of unsuccessful LAAO procedures.
Methods:
A retrospective analysis was performed on patients undergoing LAAO at our institution from 2020 to 2023. The primary endpoint was a failure to deploy the LAAO device, which was defined as unsuccessful device implantation (UDI).
Results:
A total of 411 patients underwent LAAO (Lariat = 6.8%, Amulet = 56.4%, and Watchman FLX/FLX Pro = 36.7%). UDI was observed in 4.9% (n = 20) of procedures. The cohort's mean age was 77.1 ± 10 years, and 45% were males. The mean CHA2DS2-VASc score was 4 ± 1.7, and the HASBLED score was 3.2 ± 1.4. The highest UDI rate was seen in Lariat (17.9%), followed by Watchman FLX (4.6%) and Amulet (2.2%). The primary reasons for UDI were unsatisfactory device positioning, inadequate depth attainment, anatomical incompatibility, and trabeculations impeding proper device placement. Among those with UDI, 40% underwent subsequent LAA closure using AtriClip, while the remainder continued oral anticoagulant as destination therapy. A small number had post-procedural complications.
Conclusion:
LAAO demonstrates a low failure rate and is generally safe. LAA morphology significantly influences the procedure's success, with AtriClip surgical exclusion often serving as an option after UDI.
