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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Occlusion in High Bleeding Risk Patients
Pierluigi Merella1, Giovanni Lorenzoni1, Alessandro P Delitala2
1Department of Cardiology, Ospedale San Francesco, Nuoro, Italy.
Insights
Left atrial appendage occlusion (LAAO) is safe for high-risk atrial fibrillation (AF) patients. Single antiplatelet therapy is a safe alternative to dual therapy post-LAAO, preventing stroke effectively.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) poses a significant stroke risk, particularly in patients with high bleeding risk or contraindications to oral anticoagulation.
- Left atrial appendage occlusion (LAAO) offers an alternative stroke prevention strategy for these challenging patient populations.
Purpose of the Study:
- To evaluate the safety and efficacy of LAAO in patients with nonvalvular AF and high bleeding risk.
- To analyze the optimal antithrombotic therapy strategies following LAAO in this cohort.
Main Methods:
- A monocentric study included 68 patients with nonvalvular AF and high bleeding risk or contraindication to oral anticoagulant therapy.
- Patients underwent LAAO, with follow-up assessments at 3, 6, and 12 months, and a longer-term clinical follow-up of 1.4 ± 0.9 years.
- Antithrombotic strategies post-procedure included dual antiplatelet therapy, single antiplatelet therapy, or no antithrombotic therapy.
Main Results:
- Successful LAAO was achieved in 67 out of 68 patients.
- At discharge, most patients received either dual antiplatelet therapy (47%), single antiplatelet therapy or no antithrombotic (50%), or anticoagulant therapy (3%).
- During follow-up, late adverse events were infrequent (3/62 patients), including device-related thrombus (2) and extracranial bleeding (1). Device-related thrombosis was not linked to antithrombotic regimen.
Conclusions:
- LAAO is a feasible and safe procedure for stroke prevention in AF patients unsuitable for oral anticoagulation.
- Single antiplatelet therapy appears to be a safe and effective alternative to dual antiplatelet therapy post-LAAO, especially in high bleeding risk individuals.
- Dual antiplatelet therapy did not demonstrate additional benefit in this study population.
Objectives:
The aim of this study was to investigate the outcomes of left atrial appendage occlusion (LAAO) in high bleeding risk patients suffering atrial fibrillation (AF) and to analyze the different antithrombotic therapies following the intervention.
Background Methods:
This monocentric study included 68 patients with nonvalvular AF with an absolute contraindication to OAT or at high bleeding risk. Follow-up was done with a clinical visit at 3-6-12 months.
Results:
Successful LAAO was achieved in 67/68 patients. At discharge, 32/68 patients were on dual antiplatelet therapy (APT), 34/68 were without any antithrombotic therapy or with a single antiplatelet drug, and 2/68 were on anticoagulant therapy. At three-month follow-up visit, 73.6% of the patients did not receive dual APT, of whom 14.7% had no thrombotic therapy and 58.9% were on single antiplatelet therapy. During a follow-up of 1.4 ± 0.9 years, 3/62 patients had late adverse effects (2 device-related thrombus without clinical consequences and 1 extracranial bleeding). The device-related thrombosis was not related to the antithrombotic therapy.
Conclusions:
LAAO is feasible and safe and prevents stroke in patients with AF with contraindication to oral anticoagulant therapy. After LAAO, single antiplatelet therapy seems to be a safe alternative to dual antiplatelet therapy, especially in patients at high bleeding risk. No benefit has been observed with dual APT.
