Key result
Both percutaneous and thoracoscopic left atrial appendage occlusion are viable strategies for stroke prevention in atrial fibrillation, requiring individualized selection by a multidisciplinary heart team.
Why the study?
To review the value of multimodality imaging in patient selection and compare technical advancements and indications for percutaneous and standalone thoracoscopic left atrial appendage occlusion.
The choice between percutaneous and thoracoscopic LAAO should be individualized by a multidisciplinary heart team based on patient anatomy, bleeding risk, and comorbidities, utilizing multimodality imaging for optimal patient selection.
The left atrial appendage is well recognized as the site of thrombus formation in patients with atrial fibrillation. However, in patients who are either unsuitable for long-term oral anticoagulation or in whom this therapy is inefficient, left atrial occlusion has emerged as a mechanical strategy option to diminish stroke risk. Minimally invasive percutaneous and standalone surgical thoracoscopic techniques are appearing as viable options for left atrial appendage exclusion, each with distinct procedural risk profiles and characteristics, as well as evidence from trials or registers. We suggest that the choice between percutaneous and thoracoscopic left atrial appendage occlusion should be individualized, ideally within the multidisciplinary heart team, considering left atrial appendage anatomy, patient bleeding and thromboembolic risk profile, comorbidities, prior cardiac interventions, and institutional expertise and resources. We aim to present in this review the value of multimodality imaging in patient selection for minimally invasive left atrial appendage occlusion to minimize the possibility of complications, and to compare technical advancements and indications for percutaneous and standalone thoracoscopic left atrial appendage occlusion.
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Jurinjak et al. (2026) conducted a review in Atrial Fibrillation. Left atrial appendage occlusion (percutaneous and thoracoscopic) vs. Oral anticoagulation or each other was evaluated. Both percutaneous and thoracoscopic left atrial appendage occlusion are viable strategies for stroke prevention in atrial fibrillation, requiring individualized selection by a multidisciplinary heart team.
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