January 10, 2026Circulation Reports0 citationsOpen Access

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.

TNTaisuke Nakayama HIHiroshi Ito SSShunsuke Sato

Key Result

Thoracoscopic LAAO is safe and effective for stroke prevention in AF, with high success rates and low midterm events.

Key Points

To assess the outcomes of thoracoscopic left atrial appendage occlusion with or without ablation.
Conducted a multicenter retrospective registry of 567 patients in Japan.
Compared outcomes between patients undergoing occlusion alone and those receiving concomitant ablation.
Analyzed data for complications and success rates of the procedures.
Significant improvement in outcomes for patients who received concomitant ablation.
Lower complication rates were observed in patients with occlusion alone.
Overall survival rates showed positive trends in both groups.

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?

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.

Intervention

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

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.

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.

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