ArticleFrontiers in cardiovascular medicine2026
The impact of preoperative left atrial appendage thrombus on surgical outcomes in atrial fibrillation patients undergoing epicardial left atrial appendage closure.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The presence of a left atrial appendage (LAA) thrombus is traditionally considered a contraindication to epicardial left atrial appendage closure (LAAC) because of the risk of periprocedural embolization. This presents a significant challenge for atrial fibrillation (AF) patients with a high bleeding risk who are intolerant to long-term anticoagulant treatment. The safety and outcomes of epicardial LAAC in patients with a preexisting LAA thrombus remain poorly defined. Methods: This retrospective cohort study included 108 AF patients who underwent epicardial LAAC at a single center. Patients were stratified into two groups on the basis of preoperative imaging: the Thrombus Group ( Results: No intraoperative strokes or deaths occurred in either group. Early postoperative complication rates were low and not significantly different between groups. During follow-up, the rates of thromboembolic events (1.0 vs. 2.3 per 100 patient-years) and all-cause mortality (0.3 vs. 0.0 per 100 patient-years) were comparable between the No-Thrombus and Thrombus groups, with no statistically significant differences. Thrombi confined to the LAA tip (Type I) were associated with favorable outcomes. Conclusion: Epicardial LAAC appears to be a feasible and safe alternative for stroke prevention in some AF patients with LAA thrombi who are unsuitable for anticoagulation therapy, as it does not increase perioperative risk or compromise long-term treatment efficacy.
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