Outcomes of Thoracoscopic Left Atrial Appendage Occlusion With or Without Concomitant Thoracoscopic Ablation　― Multicenter Retrospective Registry of 567 Patients in Japan ―

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=567). Intervention: Thoracoscopic Left Atrial Appendage Occlusion. Primary outcome: Freedom from stroke or transient ischemic attack.

Taisuke Nakayama; Hiroshi Ito; Shunsuke Sato; Seimei Kure; Gentaku Hama; Masakazu Aoki; Hiroshi Kodama

doi:10.1253/circrep.cr-25-0276

January 8, 2026Circulation ReportsOpen Access

Outcomes of Thoracoscopic Left Atrial Appendage Occlusion With or Without Concomitant Thoracoscopic Ablation　― Multicenter Retrospective Registry of 567 Patients in Japan ―

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Key result

Thoracoscopic LAAO in AF is associated with ~99% midterm freedom from stroke or TIA.

n=567

Figures

Why the study?

Thoracoscopic left atrial appendage occlusion, with or without ablation, is an alternative to endocardial devices or anticoagulation for stroke prevention in AF, but multicenter data are limited.

Does thoracoscopic LAAO with or without ablation prevent cerebrovascular events in patients with nonvalvular AF?

Key Points

To assess the safety, procedural success, and midterm thromboembolic outcomes of thoracoscopic left atrial appendage occlusion with or without concomitant thoracoscopic ablation.
Multicenter retrospective registry of N=567 patients with atrial fibrillation undergoing thoracoscopic left atrial appendage occlusion with or without ablation across centers in Japan.
Procedures utilized stapler closure (78%) or epicardial clip application (22%), with clinical follow-up over 875.8 patient years (median 13 months).
Procedural success was 99.8% with no intraoperative or in-hospital deaths, and residual stumps >10 mm occurred in 1.5% of patients.
Freedom from stroke or transient ischemic attack was 99.5% (0.34/100 patient years) during follow-up, with zero thromboembolic deaths.
Oral anticoagulants were discontinued immediately in 15% and within 1 month in 63% of patients, while sinus rhythm was documented in 45% at hospital discharge.

Study Design

Type

Observational (n=567)

Multicenter

Yes

Structured PICO

Does thoracoscopic LAAO with or without ablation prevent cerebrovascular events in patients with nonvalvular AF?

P

Population

567 patients with nonvalvular atrial fibrillation (paroxysmal, persistent, or long-standing persistent) considered for thoracoscopic LAAO due to contraindications to oral anticoagulants or insufficient OAC efficacy. Median age 72 years, 25% female, Japanese cohort.

I

Intervention

Thoracoscopic left atrial appendage occlusion (LAAO) using stapler excision or epicardial clip, with or without concomitant thoracoscopic ablation.

O

Outcome

Procedural success, anatomic closure, cerebrovascular events (ischemic stroke, hemorrhagic stroke, or TIA), and anticoagulant withdrawal.hard clinical

Thoracoscopic LAAO, with or without ablation, is a safe and effective stroke prevention strategy for patients with nonvalvular AF, allowing for high rates of anticoagulant withdrawal and very low midterm thromboembolic events.

Limitations

Retrospective design may introduce biases.
Non-uniform follow-up protocols may lead to underreporting of events.
Lack of standardized inclusion criteria for patients.
Retrospective, multicenter design with non-uniform follow-up schedules and imaging/rhythm evaluation protocols
Potential selection bias due to lack of standardized inclusion criteria
Incomplete data regarding postoperative anticoagulation management
Not all patients underwent postoperative ECG-gated CT or TTE
Routine rhythm monitoring was not mandated
Small number of thromboembolic events precluded subgroup analyses

Implication

Supports thoracoscopic LAAO for AF stroke prevention; leaves open role of concomitant ablation pending randomized trials.

Abstract

Background: Atrial fibrillation (AF) is a major risk factor for ischemic stroke, with >90% of thrombi in nonvalvular AF originating in the left atrial appendage (LAA). Thoracoscopic LAA occlusion (LAAO), with or without ablation, is a minimally invasive alternative to endocardial devices or anticoagulation, but multicenter data are limited. Methods and Results: VASc scores were 2 and 4, respectively. Success was 99.8% with no intraoperative deaths; residual stumps >10 mm were found in 1.5%. At discharge, sinus rhythm was present in 45%. Anticoagulants were stopped in 15% immediately and 63% within 1 month. During 875.8 patient years of follow-up (median 13 months), freedom from stroke or transient ischemic attack was 99.5% (0.34/100 patient years), with no thromboembolic deaths. Conclusions: Thoracoscopic LAAO, with or without ablation, is safe and effective for stroke prevention in AF, with high success, reliable closure, and very low midterm events.

Discussion

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Cite This Study

Nakayama et al. (2026) conducted an observational in Atrial fibrillation (n=567). Thoracoscopic Left Atrial Appendage Occlusion was evaluated on Freedom from stroke or transient ischemic attack. Thoracoscopic LAAO is safe and effective for stroke prevention in AF, with high success rates and low midterm events.

synapsesocial.com/papers/696321c091e05aa366cb800c https://doi.org/10.1253/circrep.cr-25-0276

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Outcomes of Thoracoscopic Left Atrial Appendage Occlusion With or Without Concomitant Thoracoscopic Ablation　― Multicenter Retrospective Registry of 567 Patients in Japan ―

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Outcomes of Thoracoscopic Left Atrial Appendage Occlusion With or Without Concomitant Thoracoscopic Ablation　― Multicenter Retrospective Registry of 567 Patients in Japan ―

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading

Outcomes of Thoracoscopic Left Atrial Appendage Occlusion With or Without Concomitant Thoracoscopic Ablation ― Multicenter Retrospective Registry of 567 Patients in Japan ―

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Outcomes of Thoracoscopic Left Atrial Appendage Occlusion With or Without Concomitant Thoracoscopic Ablation ― Multicenter Retrospective Registry of 567 Patients in Japan ―

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading

Outcomes of Thoracoscopic Left Atrial Appendage Occlusion With or Without Concomitant Thoracoscopic Ablation　― Multicenter Retrospective Registry of 567 Patients in Japan ―

Outcomes of Thoracoscopic Left Atrial Appendage Occlusion With or Without Concomitant Thoracoscopic Ablation　― Multicenter Retrospective Registry of 567 Patients in Japan ―