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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Closure in Patients with Atrial Fibrillation and Previous Intracerebral Hemorrhage
Pauline Renou1, Jean-Benoît Thambo2, Xavier Iriart3
1Department of Neurology, CHU de Bordeaux, Bordeaux, France.
Insights
Percutaneous left atrial appendage closure (LAAC) with single antiplatelet therapy is a safe and effective alternative for atrial fibrillation patients with prior stroke. This approach reduced stroke and bleeding risks compared to expected rates.
Area of Science:
- Cardiology
- Neurology
- Interventional Cardiology
Background:
- Atrial fibrillation (AF) patients with contraindications to anticoagulation may benefit from percutaneous left atrial appendage closure (LAAC).
- Previous spontaneous intracerebral hemorrhage (ICH) presents a significant challenge for anticoagulation management in AF patients.
- Assessing LAAC safety and efficacy with single antiplatelet therapy in this high-risk population is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of LAAC followed by single antiplatelet therapy.
- To assess the risk of ischemic strokes and hemorrhagic complications in patients with prior ICH undergoing LAAC.
- To compare observed outcomes with predicted risks based on CHA2DS2-VASc and HAS-BLED scores.
Main Methods:
- Prospective, single-center study analyzing 46 patients who underwent LAAC over 4 years.
- Risk stratification using CHA2DS2-VASc for ischemic stroke and HAS-BLED for bleeding.
- Post-procedure management with at least 6 months of single antiplatelet therapy.
- Clinical follow-up included cardiological and neurological assessments up to 12 months.
Main Results:
- The observed annual ischemic stroke rate was 4.35%, a 40% reduction from the expected 7.23% (CHA2DS2-VASc).
- The observed annual major bleeding rate was 4.35%, a 46% reduction from the expected 8.05% (HAS-BLED).
- Mean follow-up was 12 months, with acceptable periprocedural risk.
Conclusions:
- LAAC followed by single antiplatelet therapy is a feasible alternative to oral anticoagulation for high-risk AF patients with prior ICH.
- The procedure demonstrates acceptable periprocedural risk in this population.
- Longer follow-up and larger cohorts are necessary to definitively establish LAAC's effectiveness compared to direct oral anticoagulants.
Background:
Percutaneous left atrial appendage closure (LAAC) may be considered in patients with atrial fibrillation and contraindication for long-term anticoagulation. This study aimed to assess the safety and efficacy of LAAC followed by single antiplatelet therapy in patients with atrial fibrillation and previous spontaneous intracerebral hemorrhage (ICH).
Methods:
In this explorative, prospective, single-center study, consecutive patients who underwent LAAC because of previous spontaneous ICH over a period of 4 years were analyzed. Risks of ischemic strokes and hemorrhagic complications were estimated using the CHA2DS2-VASc and HAS-BLED scores, respectively. Single antiplatelet therapy was given for at least 6 months post implantation. Clinical follow-up included cardiological evaluations at 1, 3, 6, and 12 months, and neurological evaluations at 3 and 12 months.
Results:
A total of 46 patients underwent LAAC with a mean follow-up of 12 ± 7 months. The observed annual rate of ischemic stroke was 4.35% compared with an expected rate of 7.23% according to the mean risk of the population based on CHA2DS2-VASc score, which translated into a 40% risk reduction. The observed annual rate of major bleeding was 4.35% compared with an expected rate of 8.05% according to the mean risk of the population based on HAS-BLED score, which translated into a 46% risk reduction.
Conclusions:
LAAC followed by single antiplatelet therapy is feasible as an alternative to oral anticoagulation in high-risk patients with previous ICH, with an acceptable periprocedural risk. Longer follow-up in a larger number of patients will be needed to establish the effectiveness of LAAC relative to direct oral anticoagulants.
