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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Characterization of Cerebrovascular Events After Left Atrial Appendage Occlusion
Xavier Freixa1, Laura Llull1, Sameer Gafoor2
1Department of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
Insights
Cardioembolic strokes are serious, but left atrial appendage occlusion (LAAO) with the AMPLATZER Cardiac Plug (ACP) resulted in infrequent and mostly nondisabling strokes. This study evaluated stroke severity after ACP implantation in patients unable to take oral anticoagulation.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Cardioembolic strokes are often severe and disabling.
- Left atrial appendage occlusion (LAAO) is an alternative to anticoagulation for stroke prevention in atrial fibrillation.
- Previous studies (e.g., PROTECT AF with the Watchman device) suggest reduced stroke severity after LAAO, but data for the AMPLATZER Cardiac Plug (ACP) is lacking.
Purpose of the Study:
- To evaluate the severity of cerebrovascular events following LAAO with the ACP.
- To assess stroke outcomes in a patient population with contraindications to oral anticoagulation.
Main Methods:
- Analysis of data from the ACP multicenter registry.
- Inclusion of 1,047 patients undergoing LAAO.
- Definition of disabling strokes as modified Rankin score of 3-6 at 90 days post-event.
Main Results:
- High procedural success rate (97.3%) with low major adverse events (4.9%).
- Low incidence of stroke (0.9%) and transient ischemic attack (0.9%) during a median follow-up of 13 months.
- Of 16 patients with post-LAAO events, 19% experienced disabling strokes, with most on single-antiplatelet therapy.
Conclusions:
- Cerebrovascular events after LAAO with the ACP system are infrequent.
- The majority of these events are nondisabling.
- ACP appears to be a safe and effective option for stroke prevention in high-risk atrial fibrillation patients.
Abstract:
Cardioembolic strokes are generally more lethal and disabling than other source of strokes. Data from PROTECT AF (Watchman Left Atrial Appendage Closure Technology for Embolic Protection in Patients With Atrial Fibrillation) suggest that strokes after left atrial appendage occlusion (LAAO) with the Watchman device are less disabling than those in the warfarin group. No data assessing the severity of strokes after LAAO with the AMPLATZER Cardiac Plug (ACP) are available. The objective of the study was to evaluate the severity of cerebrovascular events after LAAO with the ACP in a population mostly characterized by an absolute or relative contraindication to oral anticoagulation. Data from the ACP multicenter registry were analyzed. Disabling strokes were defined as those with a modified Rankin score of 3 to 6 at 90 days after the event. A total of 1,047 subjects were included. The mean age and CHADS2 score were 75 ± 8 years and 2.8 ± 1.3, respectively. Procedural success was achieved in 97.3% and 4.9% of the patients presented procedural major adverse events. Clinical follow-up was complete in 98.2% of patients with a median of 13 months. There were 9 strokes (0.9%), 9 transient ischemic attacks (0.9%), and no intracranial hemorrhages (0%) at follow-up. After excluding 2 patients with pre-LAAO disability, functional assessment showed disabling events in 3 (19%) of the remaining 16 patients. The median time of presentation was 420 days (interquartile range 234 to 671) after LAAO, and 17 patients (94%) were on single-antiplatelet therapy when the event occurred. According to our results, cerebrovascular events after LAAO with the ACP system were infrequent and mostly nondisabling.
