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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous left atrial appendage closure in patients with prior intracranial bleeding and thromboembolism
Jussi-Pekka Pouru1, Juha Lund1, Samuli Jaakkola1
1Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
Insights
Percutaneous left atrial appendage closure (LAAC) is safe and effective for atrial fibrillation patients with a history of stroke or bleeding. This procedure offers a valid alternative to anticoagulation in high-risk individuals.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) patients often require anticoagulation to prevent stroke.
- Oral anticoagulation is contraindicated in some AF patients due to bleeding risk.
- Left atrial appendage closure (LAAC) offers an alternative treatment strategy.
Purpose of the Study:
- To evaluate the outcomes of percutaneous LAAC in patients with a history of intracranial bleeding.
- To assess the safety and efficacy of LAAC in high-risk AF patients.
Main Methods:
- A prospective registry of 104 AF patients with prior intracranial bleeding who underwent LAAC.
- Follow-up included clinical visits and phone calls up to 5 years.
- Analysis of thromboembolic and bleeding events post-LAAC.
Main Results:
- Successful LAAC was achieved in all patients, primarily using Amplatzer devices.
- The rates of thromboembolism and intracranial bleeding were 3.4 and 1.9 per 100 patient-years, respectively.
- Outcomes were similar in patients with and without prior thromboembolism, showing a 69% relative risk reduction for thromboembolism.
Conclusions:
- Percutaneous LAAC is a valid and effective treatment for AF patients with prior intracranial bleeding and thromboembolism.
- Minimized antithrombotic treatment following LAAC is feasible in this high-risk population.
Background:
Percutaneous left atrial appendage closure (LAAC) is an alternative treatment in atrial fibrillation patients with contraindication to oral anticoagulation. However, patient selection criteria for LAAC are debated.
Objective:
The purpose of this study was to evaluate the outcome after LAAC in patients with prior intracranial bleeding and thromboembolism.
Methods:
Consecutive patients with atrial fibrillation and prior intracranial bleeding who underwent LAAC from February 2009 to August 2018 at the Turku University Hospital, Finland, were included in a prospective registry. Patients were followed through clinical visits and annual phone calls up to 5 years.
Results:
Overall 104 patients (mean age 73 ± 7 years; 30% women; CHA₂DS₂-VASc score 4.7 ± 1.4; HAS-BLED score 3.3 ± 0.9) with atrial fibrillation and prior intracranial bleeding underwent successful LAAC using mainly (n = 102) Amplatzer devices. Median time from intracranial bleeding to LAAC was 7 months, and median follow-up 3.6 years. Antithrombotic treatment was ≤6 months in 71 patients (68%), and 48 patients (46%) received aspirin or clopidogrel alone. The rates of thromboembolism and intracranial bleeding (per 100 patient-years) were 3.4 and 1.9, respectively. In 39 patients with previous thromboembolism, the rate of thromboembolism was 3.6 per 100 patient-years (95% confidence interval 1.5-7.0), yielding a 69% relative risk reduction with respect to predicted risk based on median CHA2DS2-VASc score. Overall, rates of thromboembolism and intracranial bleeding were broadly similar in patients with and those without prior thromboembolism.
Conclusion:
Percutaneous LAAC with minimized antithrombotic treatment was demonstrated to be a valid treatment option in high-risk patients with prior intracranial bleeding and thromboembolism.
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