What does this research mean for the field?

Concomitant left atrial appendage amputation during cardiac surgery does not increase 30-day major surgical complications, post-operative atrial fibrillation, or fluid overload in patients without a history of atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 15, 2025Heart RhythmOpen Access

Safety of left atrial appendage amputation in cardiac surgery patients without atrial fibrillation

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Why the study?

Left atrial appendage amputation reduces stroke risk in atrial fibrillation, but its safety and functional implications in patients without atrial fibrillation undergoing cardiac surgery are uncertain.

Does left atrial appendage amputation increase major complications and supraventricular tachycardias in non-AF patients undergoing cardiac surgery?

Structured PICO

Does left atrial appendage amputation increase major complications and supraventricular tachycardias in non-AF patients undergoing cardiac surgery?

Population

434 patients without atrial fibrillation (CHA2DS2-VASc ≥2) undergoing elective cardiac surgery at 2 centers (2015-2018)

Intervention

Left atrial appendage amputation (LAAA) during elective cardiac surgery

Comparator

No left atrial appendage amputation during elective cardiac surgery

Outcome

Composite of major complications and supraventricular tachycardias within 30 dayssafety

Concomitant left atrial appendage amputation during cardiac surgery in patients without atrial fibrillation appears safe, with no increase in major complications or fluid overload, though atrial tachycardias were slightly more frequent.

Implication

Should not yet change practice for concomitant LAA amputation in non-AF surgery; leaves open RCT confirmation of safety.

Abstract

BACKGROUND: Left atrial appendage amputation (LAAA) lowers the stroke risk in patients with atrial fibrillation (AF), but its safety and functional implications in non-AF patients are uncertain. OBJECTIVE: We aimed to assess early post-operative safety of LAAA in non-AF patients undergoing cardiac surgery. METHODS: This retrospective cohort study included 434 patients without AF (CHA2DS2-VASc ≥2) who underwent elective cardiac surgery at 2 centers (2015-2018). We compared 150 patients who underwent LAAA as part of the PREventive left atrial appenDage resection for the predICtion of fuTure Atrial Fibrillation (PREDICT-AF) study, with 284 patients who declined participation and did not undergo LAAA. The primary end point was a composite of major complications and supraventricular tachycardias within 30 days. Secondary outcomes included individual complications, arrhythmias, and surrogate markers for fluid overload (weight changes, diuretic use, blood pressure, and chest x-ray congestion). Repeated measures were compared using linear mixed-effects models. 1:1 Propensity score matching was performed to assess outcomes in balanced groups. RESULTS: The LAAA group had more men (87% vs 73%, P = .001) and were heavier (86 kg [95% confidence interval: 80-92] vs 82 kg [confidence interval: 72-91], P = .001). No significant differences were observed in the primary end point (47% vs 41%, P = .321) or post-operative AF (38% vs 32%, P = .225). Atrial tachycardias were uncommon but more frequent in the LAAA cohort (4% vs 0.4%, P = .014). Procedural times and markers for fluid overload did not differ. Propensity score matching confirmed no important differences between cohorts. CONCLUSION: Concomitant LAAA was not associated with increased surgical complications, post-operative AF, or fluid overload in patients without a history of AF. These findings suggest LAAA may be a safe strategy for stroke prevention in patients undergoing cardiac surgery.