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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Closure Versus Oral Anticoagulation in Non-Valvular Atrial Fibrillation: A Systematic Review
Abdullah Al-Abcha1, Yehia Saleh2, Mahmoud Elsayed3
1Department of Internal Medicine, Michigan State University, East Lansing, MI, USA.
Insights
Left atrial appendage closure (LAAC) devices show reduced mortality and bleeding risks compared to oral anticoagulation (OAC) in non-valvular atrial fibrillation patients. Stroke and embolism risks were similar between LAAC devices and OAC.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Trials
Background:
- Left atrial appendage closure (LAAC) devices offer an alternative for non-valvular atrial fibrillation (NVAF) patients unable to use oral anticoagulation (OAC).
- Limited data exist on the comparative clinical outcomes of LAAC devices versus medical treatments.
Purpose of the Study:
- To compare the clinical outcomes of LAAC devices against OAC in NVAF patients.
- To evaluate the efficacy and safety of LAAC devices versus OAC through a meta-analysis.
Main Methods:
- A comprehensive literature search was conducted for studies comparing LAAC devices and OAC in NVAF patients up to January 1, 2021.
- A random-effects model meta-analysis was performed to calculate odds ratios (OR) and 95% confidence intervals (CIs).
Main Results:
- Five studies involving 4778 patients with a median follow-up of 2.6 years were analyzed.
- LAAC devices were associated with significantly lower risks of composite stroke, systemic embolism, and cardiovascular death (OR 0.71; 95% CI 0.51-1.00).
- LAAC also demonstrated reduced all-cause mortality, cardiovascular mortality, hemorrhagic stroke, and major bleeding events compared to OAC.
Conclusions:
- LAAC devices are associated with lower mortality and bleeding risks compared to OAC in NVAF patients.
- The risks of all stroke, ischemic stroke, and systemic embolism were comparable between LAAC devices and OAC.
Background:
Left atrial appendage closure (LAAC) devices are an alternative therapy in non-valvular atrial fibrillation (NVAF) patients with contraindications to oral anticoagulation (OAC). However, there are limited data about the clinical outcomes of LAAC devices compared to medical treatment.
Methods:
A comprehensive research for studies comparing LAAC devices and OAC for patients with NVAF was performed from inception to January 1, 2021. A meta-analysis was performed using a random effect model to calculate odds ratios (OR) with 95% confidence intervals (CIs).
Results:
Five studies were eligible that included a total of 4778 patients with a median-weighted follow-up period was 2.6 years. Compared to OAC, the LAAC device arm was associated with a lower risk of the composite of stroke, systemic embolism, and cardiovascular death (OR 0.71; 95% CI 0.51-1.00; p = 0.05). LAAC device arm was also associated with a lower risk of all-cause mortality (OR of 0.60, 95% CI 0.46-0.77; p < 0.0001), cardiovascular mortality (OR of 0.57, 95% CI 0.46-0.70; p < 0.00001), hemorrhagic stroke (OR of 0.19, 95% CI 0.07-0.50; p= 0.0006), all major bleeding (OR of 0.61, 95% CI 0.43-0.88; p = 0.007) and non-procedural major bleeding (OR of 0.46, 95% CI 0.32-0.65; p < 0.0001). There was no significant difference in all stroke, ischemic stroke, and systemic embolization between the two groups.
Conclusions:
Our meta-analysis showed lower all-cause mortality, cardiovascular mortality, hemorrhagic stroke, major bleeding, non-procedural major bleeding and the composite of stroke, systemic embolism, and cardiovascular death in the LAAC device arm when compared to OAC. However, the risk of all stroke, ischemic stroke, and systemic embolism were similar between the two arms.
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