Left Atrial Appendage Occlusion device sealing off the LAA to prevent stroke.

Closing the Gap: How Left Atrial Appendage Occlusion is Evolving for Stroke Prevention

Soraya Malik in Health & Wellness December 2025 • 4 min read.

"Two new studies shed light on the safety and efficacy of different approaches to left atrial appendage closure (LAAC), offering hope for patients at high bleeding risk."

For individuals with atrial fibrillation (AFib) who face a high risk of bleeding, the prospect of long-term anticoagulation therapy can be daunting. Fortunately, the field of stroke prevention has seen remarkable advancements, particularly in the area of left atrial appendage occlusion (LAAC). This innovative approach involves sealing off the left atrial appendage (LAA), a small pouch in the heart where blood clots are likely to form in AFib patients, thus reducing the risk of stroke.

Two recent studies presented at a major cardiology conference offer valuable insights into the evolving landscape of LAAC. The first study examines the initial multicenter experience with the Ultraseal device, a novel LAAC device, while the second compares the use of intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) in LAAC procedures using the Amulet device. Let's delve into the findings and what they mean for patients and practitioners.

These studies not only highlight the technical advancements in LAAC but also underscore the importance of tailoring treatment strategies to individual patient needs. By understanding the nuances of different devices and imaging techniques, healthcare professionals can optimize outcomes and minimize risks for patients undergoing LAAC.

Ultraseal Device: A Promising New Option for LAAC?

Left Atrial Appendage Occlusion device sealing off the LAA to prevent stroke.

The first study, titled "Ultraseal Left Atrial Appendage Occluder: Initial Multicenter Experience," investigates the safety and efficacy of the Ultraseal device. This device features a unique design with a distal bulb and a proximal sail, connected by an articulating joint. This design aims to provide a secure and adaptable seal of the LAA.

The multicenter study enrolled 126 patients across 15 Canadian and European sites. All patients had atrial fibrillation and were considered to have contraindications to long-term anticoagulation. The study meticulously collected data on periprocedural events and follow-up outcomes, including transesophageal echocardiography (TEE) performed 45 to 180 days post-procedure to assess the seal.

High Implant Success: The Ultraseal device demonstrated a high implant success rate of 97%.
Low Complication Rate: Major periprocedural adverse events occurred in only 2.4% of patients.
Favorable Antiplatelet Therapy: Ninety percent of patients were discharged on single (7%) or dual (83%) antiplatelet therapy, reducing the risk of bleeding.
Effective LAA Closure: Follow-up TEE showed no cases of large residual leaks and a low rate of device-related thrombosis (5.6%), which were successfully treated with anticoagulation therapy.
Reduced Stroke Risk: At a median follow-up of 6 months, the rate of stroke and transient ischemic attack was very low (0.8% each).

These findings suggest that the Ultraseal device is a safe and effective option for LAAC in patients with nonvalvular atrial fibrillation who are at high risk of bleeding. The device's unique design and high implant success rate may offer advantages over other LAAC devices.

The Future of LAAC: Personalized Approaches and Ongoing Innovation

The field of left atrial appendage occlusion continues to evolve, with ongoing research focused on refining techniques, optimizing device designs, and identifying the best candidates for this procedure. As technology advances and clinical experience grows, LAAC is poised to play an increasingly important role in stroke prevention for patients with atrial fibrillation, particularly those for whom long-term anticoagulation is not a viable option.

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Everything You Need To Know

What is Left Atrial Appendage Occlusion (LAAC), and why is it performed?

Left Atrial Appendage Occlusion, or LAAC, is a procedure designed to reduce the risk of stroke in individuals with atrial fibrillation (AFib), especially those who cannot take long-term anticoagulants. It involves sealing off the Left Atrial Appendage (LAA), a small pouch in the heart where blood clots are likely to form in AFib patients. By closing off this pouch, the risk of stroke is significantly reduced. LAAC does not address the underlying atrial fibrillation.

What is the Ultraseal device, and why is it considered a promising option for Left Atrial Appendage Closure (LAAC)?

The Ultraseal device is a novel Left Atrial Appendage Closure (LAAC) device used to seal off the Left Atrial Appendage (LAA) in patients with atrial fibrillation who are at high risk of bleeding and cannot take long-term anticoagulants. It has a unique design featuring a distal bulb and a proximal sail, connected by an articulating joint, which allows for a secure and adaptable seal of the LAA. The significance of the Ultraseal device lies in its high implant success rate and low complication rate, as demonstrated in initial multicenter experiences. These findings suggest it's a safe and effective option for LAAC, potentially offering advantages over other LAAC devices by reducing the risk of stroke and transient ischemic attacks.

What are intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE), and how are they used in Left Atrial Appendage Closure (LAAC) procedures?

Intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE) are both imaging techniques used during Left Atrial Appendage Occlusion (LAAC) procedures to guide the placement of the occluder device and ensure proper sealing of the Left Atrial Appendage (LAA). TEE involves inserting a probe through the esophagus to visualize the heart, while ICE uses a catheter with an ultrasound transducer inserted into the heart. The choice between ICE and TEE can impact the efficiency and safety of the LAAC procedure. Further research comparing the two will allow doctors to provide better outcomes.

Why is Left Atrial Appendage Occlusion (LAAC) considered an alternative to long-term anticoagulation therapy for some patients?

Long-term anticoagulation therapy is a standard treatment for reducing stroke risk in individuals with atrial fibrillation (AFib). However, for patients who face a high risk of bleeding, long-term anticoagulation can be dangerous. Left Atrial Appendage Closure (LAAC) offers an alternative by physically sealing off the Left Atrial Appendage (LAA), the primary source of blood clots in AFib patients, thus reducing the need for anticoagulants and lowering the risk of bleeding complications. If the LAA is closed then blood thinner usage is reduced or eliminated.

What is antiplatelet therapy, and why is it relevant in the context of Left Atrial Appendage Occlusion (LAAC)?

Antiplatelet therapy is often used after Left Atrial Appendage Occlusion (LAAC) to further reduce the risk of blood clot formation. Unlike anticoagulants, antiplatelet drugs work by preventing blood platelets from clumping together. The study on the Ultraseal device showed that a significant percentage of patients were discharged on single or dual antiplatelet therapy, which helps to minimize bleeding risks while still providing protection against stroke. Note, antiplatelet medications are not blood thinners. If blood clot formation is high after LAAC, then anticoagulants will be required.