Influence of Preoperative Left Atrial Appendage Thrombus on Surgical Results

Overview

This study investigates the impact of preoperative left atrial appendage (LAA) thrombus on outcomes in atrial fibrillation (AF) patients undergoing epicardial closure. The findings suggest that epicardial LAA closure is feasible and safe for patients with LAA thrombus, showing no significant increase in perioperative risks or long-term complications.

Background

Atrial fibrillation (AF) is a prevalent arrhythmia associated with a high risk of thromboembolic events, particularly strokes originating from the left atrial appendage (LAA). The presence of an LAA thrombus is traditionally a contraindication for epicardial left atrial appendage closure (LAAC), complicating treatment options for patients intolerant to anticoagulation. Understanding the safety and outcomes of LAAC in this patient population is crucial for optimizing stroke prevention strategies.

Data Highlights

Key Findings

• No intraoperative strokes or deaths occurred in either group.
• Early postoperative complication rates were low and comparable between groups.
• Thromboembolic event rates were similar between the No-Thrombus and Thrombus groups.
• Thrombi confined to the LAA tip (Type I) were associated with favorable outcomes.
• Epicardial LAAC is a viable option for patients with LAA thrombus who cannot tolerate anticoagulation.

Clinical Implications

Clinicians may consider epicardial LAAC as a safe alternative for stroke prevention in AF patients with LAA thrombus, particularly those at high risk for bleeding. Careful patient selection and imaging are essential to minimize perioperative risks.

Conclusion

Epicardial LAAC offers a promising approach for managing AF patients with LAA thrombus, ensuring safety and efficacy without increasing perioperative complications.

Related Resources & Content

1. Clinical Research in Cardiology, 2023 -- Frequency and Determinants of Atrial Fibrillation After Transcatheter Interatrial Septal Closure with Modern Devices
2. Clinical Research in Cardiology, 2023 -- Long-term Outcomes of Newly Developed Perioperative Atrial Fibrillation Following Left Atrial Appendage Excision During Cardiac Surgery
3. Clinical Research in Cardiology, 2026 -- Comparison of therapeutic strategies in patients presenting with left atrial thrombus despite oral anticoagulation
4. Clinical Research in Cardiology, 2020 -- Closure of the Left Atrial Appendage in Patients with Diminished Left Ventricular Ejection Fraction: Findings from the Multicenter German LAARGE Study
5. The Society of Thoracic Surgeons 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation - ScienceDirect
6. 2025 SCAI/HRS Clinical Practice Guidelines on Transcatheter Left Atrial Appendage Occlusion
7. First-in-Poland thoracoscopic left atrial appendage closure using the Novel AtriClip® PRO-V device in a patient after heart surgery and with an LAA thrombus
8. The Society of Thoracic Surgeons 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation - ScienceDirect
9. 2025 SCAI/HRS Clinical Practice Guidelines on Transcatheter Left Atrial Appendage Occlusion