An updated systematic review and meta‐analysis of early outcomes after left atrial appendage occlusion

Background Left atrial appendage occlusion (LAAO) is a promising intervention for stroke prevention in patients with non‐valvular atrial fibrillation (NVAF). Early outcomes following LAAO have been published in many studies with variable results. Objective This updated meta‐analysis aims to provide a summary of the early outcomes of LAAO. Methods Medline/Pubmed, Ovid Journals, Clinical trials, Abstract meetings, Cochrane databases were searched from January 1st, 1999 to November 30th, 2016. Results This meta‐analysis included 49 studies involving 12 415 patients. The median age was 73.5 years (IQR 72‐75 years) and 43% were males. Hypertension and diabetes were present in 36% and 15% of the population, respectively. There was a prior history of stroke and congestive heart failure in 14% and 18% of the population, respectively. The median CHADS 2 score was 2.9 (IQR 2.6‐3.3) and the median HASBLED score was 3.3 (IQR 3‐4). LAAO implantation was successful in 96.3% of patients (95.40‐97.08, I 2 = 76.1%). The pooled proportion of all‐cause mortality was 0.28% (0.19‐0.38, I 2 = 0%). The pooled proportion of all‐cause stroke was 0.31% (0.22‐0.42, I 2 = 9.4%), major bleeding requiring transfusion was 1.71% (1.13‐2.41, I 2 = 73.2%), and pericardial effusion was 3.25% (2.46‐4.14, I 2 = 79%). Sub analysis of randomized clinical trials comparing LAAO devices to warfarin showed lower mortality ( P = 0.03) with similar bleeding risk ( P = 0.20) with LAAO. Conclusions This meta‐analysis concludes that LAAO occlusion is a safe and effective stroke prevention strategy in patients with NVAF.