Related Experiment Video
Updated: Jul 12, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Occlusion versus Novel Oral Anticoagulation for Stroke Prevention in Atrial
Shmuel Tiosano1,2, Ariel Banai2,3, Wesam Mulla1,4
1Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel.
Insights
Left atrial appendage occluder (LAAO) implantation showed a significantly lower 1-year mortality risk compared to novel oral anticoagulants (NOACs) in atrial fibrillation patients. This survival benefit was more pronounced in those with impaired renal function.
Area of Science:
- Cardiology
- Medical Devices
- Pharmacology
Background:
- Atrial fibrillation (AF) increases stroke risk, necessitating anticoagulation.
- Left atrial appendage occluder (LAAO) implantation and novel oral anticoagulants (NOACs) are established AF treatments.
- Comparative survival data between LAAO and NOACs is limited.
Purpose of the Study:
- To compare the 1-year survival rates of AF patients undergoing LAAO implantation versus NOAC treatment.
- To assess the impact of renal function on survival outcomes in these patient groups.
Main Methods:
- Indirect, retrospective comparison of two independent prospective registries: LAAO (n=419) and NOACs (n=3138).
- Propensity score matching was used to balance baseline characteristics.
- Survival analysis employed Kaplan-Meier curves, log-rank tests, and multivariable Cox regression.
Main Results:
- The study included 114 LAAO patients and 342 NOAC patients after matching.
- One-year mortality was 4% for LAAO versus 9% for NOACs (unadjusted).
- LAAO implantation was associated with a significantly lower 1-year mortality risk (HR 0.38) after adjustment for confounders, particularly in patients with impaired renal function (HR 0.21).
Conclusions:
- LAAO implantation demonstrated a significantly lower 1-year mortality risk compared to NOACs in AF patients.
- The survival benefit of LAAO was more pronounced in patients with reduced renal function.
- Further prospective studies are warranted to directly compare the efficacy and safety of LAAO and NOACs.
Abstract:
Aim To compare the 1-year survival rate of patients with atrial fibrillation (AF) following left atrial appendage occluder (LAAO) implantation vs. treatment with novel oral anticoagulants (NOACs).
Methods:
We have conducted an indirect, retrospective comparison between LAAO and NOAC registries. The LAAO registry is a national prospective cohort of 419 AF patients who underwent percutaneous LAAO between January 2008 and October 2015. The NOACs registry is a multicenter prospective cohort of 3138 AF patients treated with NOACs between November 2015 and August 2018. Baseline patient characteristics were retrospectively collected from coded diagnoses of hospitalization and outpatient clinic notes. Follow-up data was sorted from coded diagnoses and the national civil registry. Subjects were matched according to propensity score. Baseline characteristics were compared using Chi-Square and student's t-test. Survival analysis was performed using Kaplan-Meier survival curves, log-rank test, and multivariable Cox regression, adjusting for possible confounding variables.
Results:
This study included 114 subjects who underwent LAAO implantation and 342 subjects treated with NOACs. The mean age of participants was 77.9 ± 7.44 and 77.1 ± 11.2 years in the LAAO and NOAC groups, respectively (p = 0.4). The LAAO group had 70 (61%) men compared to 202 (59%) men in the NOAC group (p = 0.74). No significant differences were found in baseline comorbidities, renal function, or CHA2DS2-VASc score. One-year mortality was observed in 5 (4%) patients and 32 (9%) patients of the LAAO and NOAC groups, respectively. After adjusting for confounders, LAAO was significantly associated with a lower risk for 1-year mortality (HR 0.38, 95%CI 0.14-0.99). In patients with impaired renal function, this difference was even more prominent (HR 0.21 for creatinine clearance (CrCl) < 60 mL/min).
Conclusions:
In a pooled analysis of two registries, we found a significantly lower risk for 1-year mortality in patients with AF who were implanted with LAAO than those treated with NOACs. This finding was more prominent in patients with impaired renal function. Future prospective direct studies should further investigate the efficacy and adverse effects of both treatment strategies.
Related Concept Videos
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins