Overview
Left atrial appendage (LAA) occlusion or removal is an invasive therapy for patients with atrial fibrillation (AF) aimed at reducing stroke incidence 13. This procedure can be performed during cardiac surgery or combined with catheter ablation 12. The provided abstracts do not contain information regarding "right juxtaposition" of the left atrial appendage.Diagnosis
Patients considered for LAA occlusion typically have atrial fibrillation (AF) and a CHA2DS2-VASc score ≥2 1. Post-procedure, echocardiography and cardiac computed tomography are utilized for follow-up to assess outcomes such as device endothelialization 3.Management
Left atrial appendage occlusion or removal performed at the time of cardiac surgery does not appear to increase the risk of heart failure-related hospitalization or death 1.
For patients undergoing combined LAA occlusion and catheter ablation for AF, the optimal strategy (ablation-first versus occlusion-first) remains unclear 2.
Cardiac rehabilitation (CR) is beneficial for patients with AF post-LAA occlusion, improving physical function (e.g., 6-minute walk test distance, handgrip and leg strength) and mental/physical quality of life 3.
CR also accelerates device endothelialization in patients with AF after LAA occlusion 3.Special Populations
The studies focused on patients with atrial fibrillation (AF) 123, including those with a CHA2DS2-VASc score ≥2 1.Key Recommendations
Left atrial appendage occlusion or removal performed at the time of cardiac surgery does not appear to alter the risk of heart failure-related hospitalization or death 1. (Evidence: Strong)
Cardiac rehabilitation should be considered for patients with atrial fibrillation following left atrial appendage occlusion, as it improves physical function, quality of life, and accelerates device endothelialization 3. (Evidence: Strong)
The optimal sequence (ablation-first versus occlusion-first) for combining left atrial appendage occlusion with catheter ablation in patients with atrial fibrillation during a single procedure requires further clarification 2. (Evidence: Strong)References
1 Krisai P, Belley-Cote EP, McIntyre WF, Wong J, Tsiplova K, Brady K et al.. Heart failure after left atrial appendage occlusion: Insights from the LAAOS III randomized trial. European journal of heart failure 2025. link
2 Du X, Chu H, Yang B, Zhong J, Ruan Z, Chen Q et al.. Strategy Optimization for a Combined Procedure in Patients With Atrial Fibrillation: The COMBINATION Randomized Clinical Trial. JAMA network open 2024. link
3 Wu Y, Lin J, Gong B, Wang L, Ruan Z, Xu K. Cardiac Rehabilitation in Atrial Fibrillation Patients With Left Atrial Appendage Occlusion: A RANDOMIZED TRIAL. Journal of cardiopulmonary rehabilitation and prevention 2022. link