Key result
Percutaneous left atrial appendage occlusion following electrical isolation allowed 98.15% of patients to discontinue oral anticoagulants at a median follow-up of 18.5 months, with a 2.47% stroke rate.
Why the study?
Patients with impaired LAA contractility after electrical isolation may need long-term OAC therapy regardless of CHA2DS2-VASc score, making percutaneous LAAO a potential alternative.
Does percutaneous LAA occlusion allow for safe discontinuation of oral anticoagulation and prevent thromboembolic events in patients with nonparoxysmal AF who underwent LAA electrical isolation?
Cohort (n=162)
Yes
Does percutaneous LAA occlusion allow for safe discontinuation of oral anticoagulation and prevent thromboembolic events in patients with nonparoxysmal AF who underwent LAA electrical isolation?
Percutaneous LAA occlusion allows for safe discontinuation of oral anticoagulation in up to 98% of patients who have undergone LAA electrical isolation, without an increase in thromboembolic events off-OAC.
LAAO may allow OAC discontinuation after LAA isolation; leaves open need for prospective trials on thromboembolic risk.
Introduction Electrical isolation of the left atrial appendage (LAA) is an important adjunctive ablation strategy in patients with nonparoxysmal atrial fibrillation (AF). Patients who have impaired LAA contractility following isolation may require long‐term oral anticoagulant (OAC) therapy irrespective of their CHADS 2 ‐VASc score. Percutaneous LAA occlusion (LAAO) is a potential alternative to life‐long OAC therapy. We aimed to assess the rate of OAC discontinuation and thromboembolic (TE) events following percutaneous LAAO in patients who underwent LAA electrical isolation (LAAI). Methods This is a retrospective two‐center study of patients who underwent percutaneous LAAO following LAAI. Patients with at least 3‐month follow‐up were included in the study. The antithrombotic therapy and TE events at the time of the last follow‐up were noted. Results The LAA was successfully occluded in 162 (with Watchman device in 140 [86.4%] and Lariat in 22 [13.6%]). A total of 32 patients had leaks detected on the 45‐day transesophageal echocardiogram (TEE); 21 (15%) Watchman and 11 (50%) Lariat cases ( P = 0.0001). Two (one Watchman and one Lariat) of the 32 leaks were more than 5 mm. After the 45‐day TEE, 150 (92.6%) patients were off‐OAC. No TE events were reported in the 150 patients who stopped the anticoagulants. Four (2.47%) patients experienced stroke following the LAAO (three Watchman and one Lariat) procedure while on‐OAC, two of which were fatal. At the median follow‐up of 18.5 months, 159 (98.15%) patients were off‐anticoagulant. Conclusion Up to 98% of patients with LAAI could safely discontinue OAC after undergoing the appendage closure procedure.
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Gadiyaram et al. (2019) conducted a cohort in Nonparoxysmal atrial fibrillation with LAA electrical isolation (n=162). Percutaneous left atrial appendage occlusion (LAAO) was evaluated on Rate of oral anticoagulant (OAC) discontinuation and thromboembolic events. Percutaneous left atrial appendage occlusion following electrical isolation allowed 98.15% of patients to discontinue oral anticoagulants at a median follow-up of 18.5 months, with a 2.47% stroke rate.
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