What does this research mean for the field?

Left atrial appendage closure can be performed safely in selected patients with distal left atrial appendage thrombus, achieving long-term clinical outcomes comparable to patients without thrombus. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 26, 2025Journal of Clinical MedicineOpen Access

Long-Term Clinical Outcomes of Left Atrial Appendage Closure in Patients with Left Atrial Appendage Thrombus

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Why the study?

While the feasibility and short-term safety of LAAC with pre-existing LAA thrombus have been reported, data on long-term clinical outcomes remain limited.

Does left atrial appendage closure (LAAC) result in comparable long-term outcomes in atrial fibrillation patients with versus without a pre-existing LAA thrombus?

Structured PICO

Does left atrial appendage closure (LAAC) result in comparable long-term outcomes in atrial fibrillation patients with versus without a pre-existing LAA thrombus?

Population

403 patients with atrial fibrillation undergoing left atrial appendage closure (LAAC), including 24 (6%) with an LAA thrombus at the time of the procedure.

Intervention

Left atrial appendage closure (LAAC) in the presence of a pre-existing LAA thrombus.

Comparator

Left atrial appendage closure (LAAC) in the absence of an LAA thrombus.

Outcome

5-year composite of stroke, systemic embolism, or all-cause mortality.composite

Left atrial appendage closure may be safely performed in selected patients with a distal LAA thrombus, offering long-term outcomes comparable to patients without a thrombus.

Limitations

retrospective
single-center

Implication

Comparable outcomes after LAAC in selected patients with versus without LAA thrombus; hypothesis-generating and requires randomized confirmation.

Abstract

Background: Patients with atrial fibrillation (AF) who have a high bleeding risk or contraindications to anticoagulation may be candidates for left atrial appendage closure (LAAC). However, the presence of a thrombus in the left atrial appendage (LAA) is generally considered a contraindication to the procedure. While the feasibility and short-term safety of LAAC in patients with pre-existing LAA thrombus has been reported, data on long-term outcomes remain limited. Objective: To assess the long-term clinical outcomes of AF patients undergoing LAAC in the presence of an LAA thrombus. Methods: This retrospective, single-center registry included all AF patients who underwent LAAC between June 2010 and April 2024. Patients were stratified based on the presence or absence of LAA thrombus at the time of the procedure. The primary endpoint was a 5-year composite of stroke, systemic embolism, or all-cause mortality. Results: A total of 403 patients underwent LAAC, of whom 24 (6%) had an LAA thrombus at the time of the procedure. During a median follow-up of 3.9 years, the primary endpoint occurred in 116 patients: 110 events (41%) in the no-thrombus group and 6 events (38%) in the thrombus group. There was no statistically significant difference in major adverse cardiovascular events (MACE) between groups (log-rank p = 0.862). Conclusions: LAAC may be performed safely in selected patients with distal LAA thrombus, with long-term outcomes comparable to those without thrombus.