Left Atrial Appendage Occlusion for Secondary Stroke Prevention in Patients with Atrial Fibrillation: Long-Term...

Area of Science:

• Cardiology
• Neurology
• Medical Devices

Background:

• Patients surviving an initial stroke face a higher risk of subsequent strokes.
• Left atrial appendage closure (LAAC) offers an alternative to anticoagulation for stroke prevention in atrial fibrillation (AF) patients.

Purpose of the Study:

• To assess the long-term effectiveness of LAAC for primary and secondary stroke prevention in patients with AF.
• To compare stroke and bleeding event rates between AF patients with and without a history of stroke who underwent LAAC.

Main Methods:

• Retrospective analysis of 139 AF patients undergoing LAAC, divided into a Stroke Group (37 patients) and a Control Group (102 patients).
• Cumulative follow-up of 530.1 patient-years, with an average follow-up of approximately 50 months per patient.
• Comparison of clinical characteristics, thromboembolic event rates, bleeding event rates, and mortality between the two groups.

Main Results:

• Patients with prior stroke had significantly higher CHADS2, CHA2DS2-VASc, and HAS-BLED scores.
• No significant differences in thromboembolic event rates (0.8% vs. 0.5%), bleeding event rates (0% vs. 1.4%), or mortality (0.8% vs. 2.1%) were observed between the Stroke Group and Control Group.
• Estimated risk reductions for thromboembolic and bleeding events were substantial in both groups, with particularly high reductions in the Stroke Group (89% and 100%, respectively).

Conclusions:

• LAAC is a safe and effective stroke prevention strategy in AF patients, including those with a history of stroke.
• Patients with prior stroke may benefit significantly from LAAC, irrespective of contraindications to anticoagulant therapy.
• LAAC demonstrates long-term efficacy in reducing thromboembolic events and mortality in AF patients.