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Updated: Aug 27, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous Left Atrial Appendage Occlusion in Comparison to Non-Vitamin K Antagonist Oral Anticoagulant Among
Peter A Noseworthy1,2, Holly K Van Houten1, Harlan M Krumholz3
1Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester MN.
Insights
Left atrial appendage occlusion (LAAO) showed no significant difference in composite outcomes compared to non-vitamin K antagonist oral anticoagulants for atrial fibrillation patients. LAAO was linked to lower mortality, especially in those with prior intracranial bleeding.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Atrial fibrillation (AF) patients require stroke prevention, with left atrial appendage occlusion (LAAO) and non-vitamin K antagonist oral anticoagulants (NOACs) being key options.
- Comparative effectiveness data between LAAO and NOACs are crucial for guiding clinical decisions in AF management.
Purpose of the Study:
- To compare the safety and efficacy of percutaneous left atrial appendage occlusion (LAAO) versus non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation.
- To evaluate risks of ischemic stroke, systemic embolism, major bleeding, and all-cause mortality in AF patients treated with LAAO or NOACs.
Main Methods:
- Retrospective analysis of a US administrative database including 562,850 patients with atrial fibrillation.
- 8,397 patients received LAAO, and 554,453 received NOACs between March 2015 and December 2018.
- Propensity score overlap weighting was employed to balance baseline characteristics; primary outcome was a composite of ischemic stroke/systemic embolism, major bleeding, and all-cause mortality.
Main Results:
- LAAO demonstrated no significant difference in the primary composite outcome (ischemic stroke/systemic embolism, major bleeding, all-cause mortality) compared to NOACs.
- LAAO was associated with a higher risk of major bleeding (HR, 1.22 [1.05-1.42]) but a significantly lower risk of all-cause mortality (HR, 0.73 [0.64-0.84]).
- The mortality benefit of LAAO was most pronounced in patients with a history of intracranial bleeding.
Conclusions:
- Percutaneous LAAO is a reasonable alternative to NOACs for select atrial fibrillation patients, offering a similar composite outcome risk profile.
- LAAO is associated with reduced all-cause mortality, particularly beneficial for patients with prior intracranial bleeding history.
- Higher bleeding risk with LAAO necessitates optimization of post-procedural antithrombotic strategies and proactive bleeding risk assessment.
Abstract:
Background This study aimed to compare percutaneous left atrial appendage occlusion (LAAO) with non-vitamin K antagonist oral anticoagulants among patients with atrial fibrillation. Methods and Results Using a US administrative database, 562 850 patients with atrial fibrillation were identified, among whom 8397 were treated with LAAO and 554 453 were treated with non-vitamin K antagonist oral anticoagulants between March 13, 2015 and December 31, 2018. Propensity score overlap weighting was used to balance baseline characteristics. The primary outcome was a composite end point of ischemic stroke or systemic embolism, major bleeding, and all-cause mortality. The mean age was 76.4±7.6 years; 280 097 (49.8%) were female. Mean follow-up was 1.5±1.0 years. LAAO was associated with no significant difference in the risk of the primary composite end point (hazard ratio [HR], 0.93 [0.84-1.03]), or the secondary outcomes including ischemic stroke/systemic embolism (HR, 1.07 [0.81-1.41]), and intracranial bleeding (HR, 1.08 [0.72-1.61]). LAAO was associated with a higher risk of major bleeding (HR, 1.22 [1.05-1.42], P=0.01) and a lower risk of mortality (HR, 0.73 [0.64-0.84], P<0.001). The lower risk of mortality associated with LAAO was most pronounced in patients with a prior history of intracranial bleeding. Conclusions In comparison to non-vitamin K antagonist oral anticoagulants, LAAO was associated with no significant difference in the risk of the composite outcome and a lower risk of mortality, which suggests LAAO might be a reasonable option in select patients with atrial fibrillation. The observation of higher bleeding risk associated with LAAO highlights the need to optimize postprocedural antithrombotic regimens as well as systematic efforts to assess and address bleeding predispositions.
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