Left atrial appendage closure (LAA closure) has evolved from a niche procedure into an increasingly important strategy for stroke prevention, bleeding prevention, and long-term treatment simplification in patients with atrial fibrillation (AF).
Traditionally, many patients were referred for LAA closure only after major bleeding complications.
Today, this paradigm is changing.
Recent clinical studies and growing real-world experience increasingly suggest that LAA closure may benefit a much broader atrial fibrillation population than previously assumed.
We now believe that LAA closure should not only be considered after major bleeding has already occurred.
The first major bleeding event can be catastrophic — or fatal. We want to prevent this first bleeding!
At CARDIOVASCULAR GLOBAL, treatment decisions are individualized. We do not rely exclusively on rigid checklists or simplified treatment algorithms, but instead evaluate anatomy, bleeding risk, stroke risk, frailty, lifestyle, and patient-specific goals.
Many patients are not only concerned about stroke prevention, but also about the long-term burden, bleeding risk, lifestyle limitations, and uncertainty associated with lifelong anticoagulation.
Patients we frequently see:
– patients with cerebral microbleeds
– patients with cerebral amyloid angiopathy
– patients with elevated intracranial bleeding risk
We routinely evaluate patients, including patients:
– with bleeding complications during anticoagulation
– seeking alternatives to lifelong anticoagulation
– with recurrent falls or frailty
– with kidney disease or complex multimorbidity
– considering combined AF ablation and LAA closure
– after unsuccessful prior LAA closure attempts
– with residual leaks after prior LAA closure
If you were told that LAA closure is not possible or not indicated, a structured second opinion may still be worthwhile.
A field we helped build
Our team has been involved in the field of LAA closure from the very beginning.
In 2001, Prof. Horst Sievert performed the world’s first transcatheter left atrial appendage closure procedure using the PLAATO device.
Since then, our physicians have participated in the clinical development, evaluation, and early adoption of many modern and next-generation LAA closure technologies.
This includes collaboration on emerging systems such as Omega, Append, SEAL-A, and many other innovative approaches designed to further improve safety, efficacy, and procedural simplicity.
Our physicians have also organized dedicated international educational meetings focused on LAA closure and stroke prevention, including CSI Focus LAA.
Closure techniques
Different anatomical situations and patient-specific considerations require different closure strategies.
At CARDIOVASCULAR GLOBAL, we work with all major LAA closure technologies and techniques.
Combined AF ablation and LAA closure
In many patients, AF ablation and LAA closure can be combined during the same minimally invasive procedure.
In selected patients, AF ablation and LAA closure can be combined during the same minimally invasive procedure using modern technologies including pulsed field ablation (PFA).
Recent studies such as OPTION increasingly support individualized combined strategies aimed at long-term rhythm control and reduction of anticoagulation-related bleeding risk.
Residual leaks and redo situations
Some patients are referred because of residual leaks after prior LAA closure, difficult anatomy, or unsuccessful prior procedures.
Additional dedicated information regarding residual leaks, redo procedures, and complex post-procedural situations will be available in separate sections.
Ambulatory treatment and recovery
Modern LAA closure procedures are minimally invasive and performed through a small puncture in the groin.
Many patients can leave the hospital the same day or after only one overnight stay.
Recovery is usually rapid.
International expertise and education
Our physicians have participated in international clinical research, physician training, proctoring, and device development in the field of structural heart interventions for decades.
We have also organized international educational meetings dedicated to LAA closure and stroke prevention, including CSI Focus LAA:
https://www.csi-congress.org/laa
FAQ
Q: I was told that I should stay on blood thinners for life — should I still ask for an evaluation?
A: Yes. Many patients may still be candidates for left atrial appendage closure (LAA closure), even if lifelong anticoagulation was previously recommended.
Treatment decisions should be individualized based on bleeding risk, stroke risk, anatomy, medical history, and patient preferences. A structured second opinion may help clarify available options.
Q: Can LAA closure be combined with AF ablation?
A: Yes. In many patients, AF ablation and LAA closure can be performed during the same minimally invasive procedure.
Whether a combined approach is appropriate depends on individual anatomy, AF type, stroke risk, and overall treatment goals.
Q: What if a prior LAA closure procedure elsewhere was unsuccessful?
A: An unsuccessful prior procedure does not necessarily mean that LAA closure is impossible.
Different devices, imaging strategies, and procedural techniques may still allow successful treatment in selected patients.
If you are unsure whether LAA closure may be relevant in your situation, an individualized consultation may help clarify your options.
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