Outcome of left atrial appendage occlusion in high-risk patients

Masoud, Ahmed Taher; Bartoletti, Stefano; Fairbairn, Timothy A.; Khurana, Ayush; Velavan, Periaswamy; Morrison, W.L.; Khalatbari, Afshin; Aggarwal, Suneil; Sharma, Nikhill; Kirchhof, Paulus; Gupta, Dhiraj

doi:10.1136/heartjnl-2017-312383

Cited by 14 publications

(10 citation statements)

References 30 publications

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“…Disregarding three patients in whom successful LAA was achieved with the second occluder size, the shortening of procedural times (r (25) = -0.43, p = 0.03) and fl uoroscopic times (r (25) = -0.40 p = 0.04) reached a statistical signifi cance. For comparison, Masoud et al, reached the median procedural time of 81 minutes in their study of 83 patients (7).…”

Section: Discussionmentioning

confidence: 97%

Retrospective study assessing efficacy and safety of left atrial appendage occlusion

Mišíková¹,

Haramiova²,

Juhás³

et al. 2020

BLL

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Slovakia. To evaluate procedural effi cacy and safety. BACKGROUND: Atrial fi brillation increases the risk of stroke. While anticoagulation therapy can reduce the risk of stroke, it is associated with bleeding risk and often unsatisfactory prescribed. Most thrombi form in the left atrium appendage, hence left atrium appendage occlusion may be a suitable therapeutic alternative for these patients. METHODS: This is an observational, retrospective, single-centre, case-series study including 30 patients with atrial fi brillation at a high risk of stroke, undergoing left atrial appendage occlusion from June 2015 to December 2018. RESULTS: The left atrial appendage was successfully closed in 29 (96.7 %) patients. Three months after the procedure, 4 patients had small leaks (< 2 mm). No complications were reported so far. Prior to the procedure, patients mostly received low molecular weight heparin (53.3 %). Three months after the procedure, patients mostly received acetylsalicylic acid (60.7 %) and clopidogrel (32.1 %). CONCLUSION: Left atrial appendage occlusion was shown to be an effective and safe alternative to anticoagulation therapy in patients with atrial fi brillation, at a high risk of stroke and bleeding. The procedure is safe, when performed carefully even by less experienced cardiologists (Tab. 6, Fig. 4, Ref.

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Section: Discussionmentioning

confidence: 97%

Retrospective study assessing efficacy and safety of left atrial appendage occlusion

Mišíková¹,

Haramiova²,

Juhás³

et al. 2020

BLL

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“…For research purposes, mCARS provides a reliable method for estimating residual stroke risk despite anticoagulation. This is particularly applicable to single-arm studies that focus on alternative methods of stroke prevention in AF [ 24 ], as it allows the stroke risk following intervention to be compared to estimated risk if anticoagulation therapy had been utilised instead. Furthermore, with increasing evidence of the benefits of catheter ablation in AF [ 25 , 26 , 27 , 28 ], this tool may be used to identify patients with a high residual stroke risk despite anticoagulation, who may benefit from more aggressive treatment (and follow-up).…”

Section: Discussionmentioning

confidence: 99%

Prediction of Residual Stroke Risk in Anticoagulated Patients with Atrial Fibrillation: mCARS

Ding

Rivera‐Caravaca

Marin

et al. 2021

JCM

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Our ability to evaluate residual stroke risk despite anticoagulation in atrial fibrillation (AF) is currently lacking. The Calculator of Absolute Stroke Risk (CARS) has been proposed to predict 1-year absolute stroke risk in non-anticoagulated patients. We aimed to determine whether a modified CARS (mCARS) may be used to assess the residual stroke risk in anticoagulated AF patients from ‘real-world’ and ‘clinical trial’ cohorts. We studied patient-level data of anticoagulated AF patients from the real-world Murcia AF Project and AMADEUS clinical trial. Individual mCARS were estimated for each patient. None of the patients were treated with non-vitamin K antagonist oral anticoagulants. The predicted residual stroke risk was compared to actual stroke risk. 3503 patients were included (2205 [62.9%] clinical trial and 1298 [37.1%] real-world). There was wide variation of CARS for each category of CHA2DS2-VASc score in both cohorts. Average predicted residual stroke risk by mCARS (1.8 ± 1.8%) was identical to actual stroke risk (1.8% [95% CI, 1.3–2.4]) in the clinical trial, and broadly similar in the real-world (2.1 ± 1.9% vs. 2.4% [95% CI, 1.6–3.4]). AUCs of mCARS for prediction of stroke events in the clinical trial and real-world were 0.678 (95% CI, 0.598–0.758) and 0.712 [95% CI, 0.618–0.805], respectively. mCARS was able to refine stroke risk estimation for each point of the CHA2DS2-VASc score in both cohorts. Personalised residual 1-year absolute stroke risk in anticoagulated AF patients may be estimated using mCARS, thereby allowing an assessment of the absolute risk reduction of treatment and facilitating a patient-centred approach in the management of AF. Such identification of patients with high residual stroke risk could help target more aggressive interventions and follow-up.

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“…Hence, it would be reasonable to propose that LAAO devices lead to a similar if not better outcome when it comes to stroke prevention compared to OAC. Numerous other studies also support this argument [8,13,14]. To date, the most aggressively evaluated LAAO device is the Watchman device.…”

Section: Figure 1: Safety Concerns With Laao and Oacmentioning

confidence: 91%

Comparison Between Oral Anticoagulation and Left Atrial Appendage Occlusion in the Prevention of Stroke With Regard to Non-Valvular Atrial Fibrillation

Sandhu¹,

Aftab²,

Anthony³

et al. 2020

Cureus

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In the past, the most common type of atrial fibrillation leading to stroke was valvular; this was predominantly due to the prevalence of rheumatic fever, but with the advent of better-hospitalized care, the cases of valvular atrial fibrillation declined. In recent years, there has been an increase in cases of stroke due to non-valvular atrial fibrillation. Stasis of blood in the left atrial pouch leads to coagulation and thrombi formation, which may lead to stroke. Oral medication or mechanical intervention can prevent thrombi formation. Both oral anticoagulation and left atrial appendage occlusion (LAAO) have been compared to see which has better outcomes. It was observed that LAAO has greater efficacy, but with time throughout a couple of years, no considerable difference was seen when compared to warfarin. Most of the long-term randomized controlled trials have been performed with the Watchman ® device. Although the Lariat and Amplatzer LAAO devices have also shown favorable outcomes, there is still a deficiency when it comes to trials of high-quality evidence using these devices as an intervention. Dual therapy with both of these approaches showed a decline in the count of major bleeding episodes on follow-up. Overall, albeit both methods have proven useful, LAAO has a slight advantage in efficacy and leads to less hemorrhagic events.

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Outcome of left atrial appendage occlusion in high-risk patients

Cited by 14 publications

References 30 publications

Retrospective study assessing efficacy and safety of left atrial appendage occlusion

Retrospective study assessing efficacy and safety of left atrial appendage occlusion

Prediction of Residual Stroke Risk in Anticoagulated Patients with Atrial Fibrillation: mCARS

Comparison Between Oral Anticoagulation and Left Atrial Appendage Occlusion in the Prevention of Stroke With Regard to Non-Valvular Atrial Fibrillation

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