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Stroke Risk in Patients With Atrial Fibrillation Undergoing Electrical Isolation of the Left Atrial Appendage

Luigi Di Biase1, Sanghamitra Mohanty2, Chintan Trivedi2

  • 1Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York. Electronic address: https://twitter.com/luigidibiasemd.

Journal of the American College of Cardiology
|August 24, 2019
PubMed

Insights

Left atrial appendage electrical isolation (LAAEI) can increase stroke risk. Maintaining oral anticoagulation (OAC) or using left atrial appendage occlusion (LAAO) devices effectively reduces this risk in patients with impaired LAA function.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Thrombosis Research

Background:

  • Left atrial appendage electrical isolation (LAAEI) may lead to impaired blood flow and thrombus formation.
  • Assessing the risk of thromboembolic events (TE) post-LAAEI is crucial for patient management.

Purpose of the Study:

  • To evaluate the incidence of TE in patients after LAAEI, comparing outcomes with and without oral anticoagulation (OAC).
  • To determine the impact of left atrial appendage (LAA) function on TE risk following LAAEI.

Main Methods:

  • Analysis of 1,854 consecutive patients undergoing LAAEI, with 6-month follow-up transesophageal echocardiography (TEE) to assess LAA function.
  • Comparison of TE event rates between patients on OAC and those off OAC, stratified by LAA function.

Main Results:

  • 18% of patients (336/1854) demonstrated preserved LAA function post-LAAEI and were managed without OAC, experiencing no stroke events.
  • Patients with abnormal LAA function had significantly higher TE rates when off OAC (16.7%) compared to those on OAC (1.7%).
  • Left atrial appendage occlusion (LAAO) devices were effective in reducing TE events in patients with abnormal LAA function, allowing discontinuation of OAC in most cases.

Conclusions:

  • LAAEI is associated with a significant stroke risk, particularly in patients with impaired LAA contractility.
  • Optimal uninterrupted OAC or LAAO devices are effective strategies for mitigating stroke risk after LAAEI.
Abstract

Keywords:
LAA functionatrial fibrillationcatheter ablationleft atrial appendage electrical isolationleft atrial appendage occlusionoral anticoagulantthromboembolic events

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