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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Percutaneous left atrial appendage closure in patients with gastrointestinal bleeding associated with oral

Patricia Sanz Segura1, Javier Jimeno Sánchez2, José Miguel Arbonés-Mainar3,4,5

  • 1Gastroenterology Department, Royo Villanova Hospital, Zaragoza, Spain.

Scandinavian Journal of Gastroenterology
|July 25, 2023
PubMed

Insights

Percutaneous left atrial appendage closure (LAAC) significantly reduced gastrointestinal bleeding and chronic anemia in atrial fibrillation patients. This procedure also led to substantial reductions in healthcare resource utilization, offering a safe alternative to oral anticoagulation.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Gastroenterology

Background:

  • Atrial fibrillation (AF) patients often require oral anticoagulation (OAC) to prevent stroke.
  • OAC is associated with an increased risk of gastrointestinal bleeding (GIB) and chronic anemia.
  • Left atrial appendage closure (LAAC) is an alternative stroke prevention strategy in AF.

Purpose of the Study:

  • To evaluate the effectiveness of percutaneous LAAC in reducing GIB and chronic anemia in AF patients.
  • To assess the impact of LAAC on healthcare resource consumption compared to OAC.
  • To determine the safety of LAAC as an alternative to OAC in specific patient populations.

Main Methods:

  • Prospective, single-center study conducted from 2016 to 2022.
  • Collected clinical, analytical, and healthcare resource data (endoscopies, transfusions, hospitalizations) before and 6 months after LAAC.
  • Included 43 patients (average age 77.6 years) with indications for LAAC due to GIB.

Main Results:

  • LAAC significantly reduced packed red blood cell transfusions (7.29 to 0.42 per patient, p < 0.001).
  • Endoscopic procedures and hospitalizations decreased dramatically post-LAAC (p < 0.001 for both).
  • Mean hemoglobin levels improved significantly (8.1 to 12.4 g/dL, p < 0.001) with no reported thromboembolic events.

Conclusions:

  • Percutaneous LAAC is a safe and effective alternative to OAC for AF patients with significant GIB.
  • LAAC can resolve chronic anemia and reduce the need for transfusions and hospitalizations.
  • This intervention offers considerable savings in healthcare resource utilization.
Abstract

Keywords:
Oral anticoagulationatrial fibrillationgastrointestinal bleedinghealth resourcesinterventional cardiologyleft atrial appendage occlusion

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