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Published on: February 26, 2013
Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation and Cancer
Samuel A Shabtaie1, Nicholas Y Tan1, Robert C Ward1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Left atrial appendage occlusion (LAAO) effectively reduces stroke risk in cancer patients with atrial fibrillation (AF) without increasing bleeding risk. This procedure offers similar safety and efficacy compared to non-cancer patients.
Area of Science:
- Cardiology
- Oncology
- Medical Devices
Background:
- Managing stroke risk in atrial fibrillation (AF) patients with cancer presents unique challenges due to heightened bleeding and thrombotic risks.
- Anticoagulation therapy is often contraindicated or requires careful management in these high-risk patients.
Purpose of the Study:
- To evaluate the safety and effectiveness of left atrial appendage occlusion (LAAO) for stroke prevention in cancer patients with AF.
- To assess if LAAO can reduce stroke risk without increasing bleeding complications in this vulnerable population.
Main Methods:
- A retrospective review of nonvalvular AF patients who underwent LAAO from 2017-2020 at Mayo Clinic.
- Inclusion criteria involved patients with prior or current cancer treatment.
- Comparison of stroke, bleeding, device complications, and mortality rates between cancer patients and a control group without malignancy.
Main Results:
- The study included 55 cancer patients (80% male, mean age 79) with high stroke risk (CHA2DS2-VASc score 5) and a history of bleeding (85.5%).
- Over one year, 1.4% experienced ischemic stroke, 10.7% had bleeding complications, and 6.5% died.
- LAAO in cancer patients showed no significant difference in ischemic stroke (HR: 0.44), bleeding (HR: 0.71), or death (HR: 1.39) compared to controls.
Conclusions:
- Left atrial appendage occlusion (LAAO) is a safe and effective procedure for stroke risk reduction in cancer patients with AF.
- The outcomes for cancer patients undergoing LAAO were comparable to those without malignancy, indicating no increased bleeding risk.
Background:
The prevention of stroke in patients with atrial fibrillation (AF) and cancer is challenging because patients are at increased bleeding and thrombotic risk.
Objectives:
The authors sought to assess left atrial appendage occlusion (LAAO) as a safe and effective strategy for reducing stroke at no increased bleeding risk in cancer patients with AF.
Methods:
We reviewed patients with nonvalvular AF who underwent LAAO at Mayo Clinic sites from 2017 to 2020 and identified those who had undergone prior or current treatment for cancer. We compared the incidence of stroke, bleeding, device complications, and death with a control group who underwent LAAO without malignancy.
Results:
Fifty-five patients were included; 44 (80.0%) were male, and the mean age was 79.0 ± 6.1 years. The median CHA2Ds2-VASc score was 5 (Q1-Q3: 4-6), with 47 (85.5%) having a prior bleeding event. Over the first year, ischemic stroke occurred in 1 (1.4%) patient, bleeding complications in 5 (10.7%) patients, and death in 3 (6.5%) patients. Compared with controls who underwent LAAO without cancer, there was no significant difference in ischemic stroke (HR: 0.44; 95% CI: 0.10-1.97; P = 0.28), bleeding complication (HR: 0.71; 95% CI: 0.28-1.86; P = 0.19), or death (HR: 1.39; 95% CI: 0.73-2.64; P = 0.32).
Conclusions:
Within our cohort, LAAO in cancer patients was achieved with good procedural success and offered a reduction in stroke at no increased bleeding risk similar to noncancer patients.
