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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

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Left Atrial Appendage Occlusion in the Elderly: Insights From PROTECT-AF, PREVAIL, and Continuous Access Registries

Samian Sulaiman1, Kristine Roy2, Hong Wang2

  • 1Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA.

JACC. Clinical Electrophysiology
|March 8, 2023
PubMed

Insights

Elderly patients aged 80 and over benefit similarly from left atrial appendage occlusion (LAAO) compared to younger patients. Age should not be a barrier to LAAO for suitable candidates, despite higher event rates in octogenarians.

Area of Science:

  • Cardiology
  • Medical Devices
  • Geriatric Medicine

Background:

  • Limited data exist on the safety and efficacy of left atrial appendage occlusion (LAAO) in elderly patients.
  • Elderly populations often have higher risks for cardiovascular events and complications.

Purpose of the Study:

  • To compare the outcomes of LAAO between patients aged 80 years and older (octogenarians) and those younger than 80.
  • To determine if advanced age impacts the effectiveness and safety of LAAO device implantation.

Main Methods:

  • Analysis of patients from randomized trials and registries using the Watchman 2.5 device.
  • Primary endpoint: composite of cardiovascular death, stroke, or systemic embolism at 5 years.
  • Secondary endpoints included death, stroke, embolism, and bleeding events; survival and treatment effects were analyzed using statistical models.

Main Results:

  • Procedural complication rates at 7 days were similar between patients ≥80 and <80 years old.
  • The primary efficacy endpoint showed no significant interaction between age and treatment effect (P=0.48).
  • Average treatment effects of LAAO compared to warfarin were similar across both age groups.

Conclusions:

  • Octogenarians experience similar benefits from LAAO as younger patients, despite higher baseline event rates.
  • Left atrial appendage occlusion is a viable treatment option for elderly patients who are otherwise suitable candidates.
  • Age alone should not be a contraindication for considering LAAO.
Abstract

Keywords:
atrial fibrillationleft atrial appendage occlusionoctogenarianstroke

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