Key result
Percutaneous left atrial appendage occlusion is associated with specific adverse events in certain subgroups and requires further large-scale studies before recommendation as first-line therapy.
Why the study?
Should percutaneous left atrial appendage occlusion be offered as first-line therapy to all patients with atrial fibrillation?
Should percutaneous left atrial appendage occlusion be offered as first-line therapy to all patients with atrial fibrillation?
LAA occlusion should be reserved for select patients with atrial fibrillation due to limited head-to-head data against DOACs and increased adverse events in certain subgroups.
LAA occlusion should be reserved for select AF patients; leaves open its first-line role pending large RCTs vs DOACs.
Key Findings▪Percutaneous left atrial appendage (LAA) occlusion has emerged as an alternative strategy to oral anticoagulants in selected patients with atrial fibrillation.▪The landmark trials comparing LAA occlusion to an oral anticoagulation strategy enrolled patients with no apparent contraindications to the use of warfarin.▪LAA occlusion has limited head-to-head comparison against the direct-acting oral anticoagulants.▪Observational data to date have generally shown specific adverse events after LAA occlusion in specific subgroups of patients (women, patients with kidney disease and heart failure, patients belonging to racial/ethnic subgroups and with advanced age), but further large-scale studies are necessary to elucidate reasons for increased adverse events associated with LAA occlusion in these subgroups of patients before recommending this modality as first-line therapy in all patient groups. ▪Percutaneous left atrial appendage (LAA) occlusion has emerged as an alternative strategy to oral anticoagulants in selected patients with atrial fibrillation.▪The landmark trials comparing LAA occlusion to an oral anticoagulation strategy enrolled patients with no apparent contraindications to the use of warfarin.▪LAA occlusion has limited head-to-head comparison against the direct-acting oral anticoagulants.▪Observational data to date have generally shown specific adverse events after LAA occlusion in specific subgroups of patients (women, patients with kidney disease and heart failure, patients belonging to racial/ethnic subgroups and with advanced age), but further large-scale studies are necessary to elucidate reasons for increased adverse events associated with LAA occlusion in these subgroups of patients before recommending this modality as first-line therapy in all patient groups.
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Munir et al. (2022) conducted a review in Atrial fibrillation. Percutaneous left atrial appendage (LAA) occlusion vs. Oral anticoagulants was evaluated. Percutaneous left atrial appendage occlusion is associated with specific adverse events in certain subgroups and requires further large-scale studies before recommendation as first-line therapy.
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