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Updated: Oct 5, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Closure Yields Favorable Cardio- and Cerebrovascular Outcomes in Patients With Non-valvular
Mingzhong Zhao1,2, Mengxi Zhao3, Cody R Hou4
1Department of Cardiology, Helmut-G-Walther-Klinikum, Lichtenfels, Germany.
Insights
Left atrial appendage closure (LAAC) effectively reduces thromboembolism and bleeding in non-valvular atrial fibrillation (NVAF) patients. Patients with prior stroke showed greater thromboembolism risk reduction after LAAC, suggesting enhanced cardiovascular benefits.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Non-valvular atrial fibrillation (NVAF) patients with prior stroke face elevated risks of recurrent stroke.
- Limited data exists on the efficacy of left atrial appendage closure (LAAC) in this high-risk NVAF population.
- Understanding LAAC's impact on cardio-cerebrovascular outcomes in NVAF patients with prior stroke is crucial.
Purpose of the Study:
- To compare the efficacy of LAAC in NVAF patients with and without a history of stroke.
- To investigate long-term cardio- and cerebrovascular outcomes following LAAC in these patient groups.
- To determine if prior stroke influences the effectiveness of LAAC.
Main Methods:
- 370 NVAF patients undergoing LAAC were divided into 'stroke' and 'non-stroke' groups.
- Follow-up assessed thromboembolism, major bleeding, device-related thrombus (DRT), and mortality.
- Statistical analysis compared outcomes between the groups, considering baseline risk scores (CHA2DS2-VASc, HAS-BLED).
Main Results:
- The stroke group had higher baseline CHA2DS2-VASc and HAS-BLED scores.
- No significant differences in thromboembolism, DRT, or major bleeding rates between groups post-LAAC.
- LAAC significantly reduced predicted risks of thromboembolism and major bleeding in both groups.
- Greater relative risk reduction in thromboembolism observed in the prior stroke group (OR 2.45, P=0.016).
- Cardiovascular death risk was significantly decreased in the stroke group post-LAAC.
Conclusions:
- NVAF patients with prior stroke do not experience worse clinical outcomes after LAAC compared to those without prior stroke.
- LAAC may offer superior cardio-cerebrovascular outcome benefits for NVAF patients with a history of stroke.
- Further research is warranted to confirm LAAC's enhanced efficacy in high-risk stroke patients.
Abstract:
Introduction: Patients with non-valvular atrial fibrillation (NVAF) and previous stroke are at significantly higher risk of stroke recurrence. Data on the efficacy of left atrial appendage closure (LAAC) on these patients is limited. The aim of this study was to investigate the differences of LAAC efficacy on long-term cardio- and cerebrovascular outcomes in NVAF patients with vs. without prior stroke. Methods: Three hundred and seventy consecutive NVAF patients who underwent LAAC were enrolled and divided into stroke and non-stroke groups based on history of previous stroke. Endpoints, such as thromboembolism, major bleeding, and mortality post-LAAC, were followed up among groups. Results: Patients in the stroke group had higher mean CHA2DS2-VASc and HAS-BLED scores compared to the non-stroke group (5.1 vs. 3.6 and 4.1 vs. 3.4, both P < 0.001, respectively). Over a median follow-up of 2.2 years, there were no significant differences in incidence rates of thromboembolism, device-related thrombus (DRT), major bleeding, and combined efficacy endpoints between the two groups. In both stroke and non-stroke groups, LAAC decreased the risk of thromboembolism [relative risk reduction (RRR) 87.5%, P = 0.034, and 74.6%, P = 0.004, respectively] and major bleeding (RRR 68.8%, P = 0.034, and 68.6%, P = 0.007, respectively) compared with predicted risk. The RRR in thromboembolism was greater in patients with vs. without prior stroke (OR 2.45, 95% CI: 1.20-5.12, P = 0.016). The incidence rates of all-cause mortality and non-cardiovascular death were similar between the two groups, but the risks of cardiovascular death post-LAAC both before (1.4% vs. 8.1%, respectively, P = 0.038) and after adjustment for confounding factors (P = 0.048) were significantly decreased in the stroke group. Conclusions: Patients with vs. without prior stroke did not exhibit a worse clinical prognosis after LAAC. LAAC may provide an increased benefit in cardio-cerebrovascular outcomes in patients with previous stroke compared to those without previous stroke. Further research is necessary to evaluate the efficacy of LAAC in this field.
