Related Experiment Video
Updated: Nov 27, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Comparative data on left atrial appendage occlusion efficacy and clinical outcomes by age group in the Amplatzer™
Xavier Freixa1, Boris Schmidt2, Patrizio Mazzone3
1Department of Cardiology, Hospital Clinic I Provincial de Barcelona, Barcelona, Spain.
Insights
Left atrial appendage occlusion (LAAO) effectively reduces stroke risk in non-valvular atrial fibrillation (NVAF) patients across all age groups. While major bleeding and mortality increase with age, LAAO remains a safe and effective stroke prevention strategy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Left atrial appendage occlusion (LAAO) is an alternative for non-valvular atrial fibrillation (NVAF) patients contraindicated for anticoagulation.
- Aging is associated with increased risks of stroke and bleeding in NVAF patients.
- Understanding the impact of age on LAAO outcomes is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the impact of aging on short- and long-term outcomes following LAAO.
- To compare LAAO efficacy and safety across different age strata (<70, 70-79, and ≥80 years).
Main Methods:
- Prospective, multicenter study (Amplatzer™ Amulet™ Occluder Observational Study) of 1088 NVAF patients undergoing LAAO.
- Subjects categorized into three age groups: <70, ≥70 and <80, and ≥80 years.
- Assessment of procedural success, serious adverse events (SAEs), ischemic stroke, major bleeding, mortality, and device-related thrombus over 2-year follow-up.
Main Results:
- High implant success rates (≥98.5%) observed across all age groups.
- Procedural SAE rates were similar among age groups.
- LAAO significantly reduced ischemic stroke risk compared to predicted rates in all age groups (62-85% reduction).
- Major bleeding and mortality rates increased with age.
- Device-related thrombus incidence showed a trend of increase with age.
Conclusions:
- LAAO is a safe and effective stroke prevention strategy in NVAF patients across all age groups, including the elderly.
- Despite increased baseline risks, LAAO achieves substantial stroke risk reduction compared to predicted rates.
- Age-related increases in bleeding and mortality warrant careful consideration but do not negate LAAO's benefits.
Aims:
Left atrial appendage occlusion (LAAO) may be considered for patients with non-valvular atrial fibrillation (NVAF) and a relative/formal contraindication to anticoagulation. This study aimed to summarize the impact of aging on LAAO outcomes at short and long-term follow-up.
Methods And Results:
We compared subjects aged <70, ≥70 and <80, and ≥80 years old in the prospective, multicentre Amplatzer™ Amulet™ Occluder Observational Study (Abbott, Plymouth, MN, USA). Serious adverse events (SAEs) were reported from implant through a 2-year post-LAAO visit and adjudicated by an independent clinical events committee. Overall, 1088 subjects were prospectively enrolled. There were 265 subjects (24.4%) <70 years old, 491 subjects (45.1%) ≥70 and <80 years old, and 332 subjects (30.5%) ≥80 years old, with the majority (≥80%) being contraindicated to anticoagulation. As expected, CHA2DS2-VASc and HAS-BLED Scores increased with age. Implant success was high (≥98.5%) across all groups, and the proportion of subjects with a procedure- or device-related SAE was similar between groups. At follow-up, the observed ischaemic stroke rate was not significantly different between groups, and corresponding risk reductions were 62, 56, and 85% when compared with predicted rates for subjects <70, ≥70 and <80, and ≥80 years old, respectively. Major bleeding and mortality rates increased with age, while the incidence of device-related thrombus tended to increase with age.
Conclusions:
Despite the increased risk for ischaemic stroke with increasing age in AF patients, LAAO reduced the risk for ischaemic stroke compared with the predicted rate across all age groups without differences in procedural SAEs.
