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Updated: Aug 14, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous and surgical left atrial appendage occlusion in non-valvular atrial fibrillation: Contemporary narrative
Julian A Chestaro1, Hannah Price1, Joel Matthews2
1Grand Strand Medical Center, Myrtle Beach, South Carolina, USA.
Insights
Left atrial appendage occlusion (LAAO) via surgical or percutaneous methods effectively reduces stroke risk in atrial fibrillation patients. Current evidence does not show one method is superior, with more data supporting percutaneous LAAO.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Atrial fibrillation (AF) patients contraindicated for oral anticoagulation (OAC) face high thromboembolic risk.
- Left atrial appendage occlusion (LAAO) offers an alternative to reduce this risk.
- Both surgical (S-LAAO) and percutaneous (pLAAO) approaches exist, but direct comparative data is limited.
Purpose of the Study:
- To review and compare the evidence for S-LAAO and pLAAO.
- To assess procedural safety, thromboembolic outcomes, and LAA exclusion completeness.
- To evaluate the role of various imaging modalities in LAAO.
Main Methods:
- Contemporary narrative review of randomized controlled trials (RCTs) and systematic reviews (SRs).
- Focused literature search on safety, efficacy, and imaging.
- Assessment of pre-, intra-, and post-procedural imaging evidence.
Main Results:
- Both S-LAAO and pLAAO reduce thromboembolic events.
- S-LAAO shows strong evidence when performed during cardiac surgery; isolated S-LAAO evidence is limited.
- pLAAO demonstrates noninferiority to OAC in select populations; incomplete occlusion is a concern for both methods.
Conclusions:
- S-LAAO and pLAAO are effective in reducing thromboembolic risk, with no established superiority.
- Evidence is more robust for pLAAO, while S-LAAO is mainly studied in conjunction with cardiac surgery.
- Further comparative studies are needed, focusing on residual patency, antithrombotic therapy, and advanced imaging.
Background:
Left atrial appendage occlusion (LAAO) reduces thromboembolic risk in patients with atrial fibrillation (AF) who have contraindications to oral anticoagulation (OAC). LAAO can be performed surgically (S-LAAO) or percutaneously (pLAAO), but direct comparative evidence remains limited.
Methods:
We conducted a contemporary narrative review of evidence for S-LAAO and pLAAO, emphasizing randomized controlled trials (RCTs) and systematic reviews (SRs), with and without meta-analyses. A focused PubMed/MEDLINE search evaluated procedural safety, thromboembolic outcomes, and completeness of LAA exclusion. Preprocedural, intraprocedural, and postprocedural imaging evidence was additionally assessed using guidelines, expert consensus statements, observational studies, and emerging clinical trials.
Results:
RCTs and SRs support both S-LAAO and pLAAO for reducing thromboembolic events. S-LAAO reduces stroke and systemic embolism when performed during concomitant cardiac surgery, with the strongest evidence from LAAOS III. Evidence for isolated S-LAAO, including epicardial AtriClip closure, remains limited. pLAAO has been evaluated in multiple RCTs and SRs and has demonstrated noninferiority to OAC in selected populations. Incomplete LAA exclusion remains a concern with both approaches, manifesting as residual stumps after surgical closure and peri-device leaks after percutaneous implantation. TEE and cardiac CT remain key imaging modalities, while ICE, CMR, and DSA/fluoroscopy-guided techniques are increasingly investigated.
Conclusion:
Both S-LAAO and pLAAO effectively reduce thromboembolic risk; however, evidence does not establish superiority of one approach. Evidence is substantially greater for pLAAO, whereas S-LAAO is primarily studied during concomitant cardiac surgery. Direct comparative studies are needed. Future research should address residual LAA patency, postprocedural antithrombotic therapy, and emerging imaging strategies.
