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Left atrial appendage closure viable option to anticoagulation in nonvalvular AF
Left atrial appendage occlusion is safe and effective in preventing strokes in patients with nonvalvular atrial fibrillation, according to data published in the Journal of Interventional Cardiology.
The systematic review and meta-analysis from Charan Yerasi, MD, from St. Joseph’s Hospital and Medical Center in Phoenix, and colleagues provided a summary of early outcomes of left atrial appendage occlusion (LAAO).
“There is a skepticism and lack of consensus with respect to the role of LAAO as a stroke prevention strategy in patients with AF,” the researchers wrote. “The skepticism is based on the lack of stroke prevention data for four of five devices currently in use worldwide.”
To evaluate the procedural safety and complications of all transcatheter LAAO devices and compare procedural events across different LAA closure devices, Yerasi and colleagues included 49 studies that enrolled 12,415 patients (mean age, 74 years; 43% men).
The researchers found that hypertension and diabetes were present in 36% and 15% of the population, respectively.
There was a prior history of stroke and congestive HF in 14% and 18% of the population, respectively.
The researchers observed a median CHADS2 score of 2.9 and a median HAS-BLED score of 3.3.
The rate of successful LAAO implantation was 96.3% (95% CI, 95.4-97.8; I2=76.1%).
The pooled proportion of allcause mortality was 0.28% (95% CI, 0.19-0.38; I2=0%) among patients enrolled in the meta-analysis.
Additionally, researchers observed a pooled proportion of allcause stroke of 0.31% (95% CI, 0.220.42, I2=9.4%), major bleeding requiring transfusion of 1.71% (95% CI, 1.132.41; I2=73.2%) and pericardial effusion of 3.25% (95% CI, 2.464.14; I2=79%).
In a subanalysis of clinical trials comparing LAAO devices to warfarin, there was lower mortality for warfarin (P=.03) with similar bleeding risk (P=.2) compared with LAAO.
“For a prophylactic procedure like LAAO, there is a fine balance between the upfront risk of the procedure and the continued risk of anticoagulation,” the researchers wrote. “With the maturation of this technique, the postprocedural risks have been significantly reduced for all devices. This meta-analysis confirms these findings and makes the case for wider offering of LAAO therapy as an alternative to anticoagulation for patients with high stroke and bleeding risks associated with atrial fibrillation.” – by Dave Quaile
Disclosures: The authors report no relevant financial disclosures.