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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Percutaneous left atrial appendage closure for stroke prevention in hypertrophic cardiomyopathy patients with atrial
Amro Aglan1, Ayman R Fath2, Barry J Maron1
1Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts.
Insights
Percutaneous left atrial appendage closure (LAAC) did not reduce stroke risk in hypertrophic cardiomyopathy patients with atrial fibrillation. LAAC may be suitable for those unable to tolerate anticoagulation due to bleeding risk.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Research
Background:
- Percutaneous left atrial appendage closure (LAAC) is an alternative stroke prevention strategy for atrial fibrillation (AF) patients at high bleeding risk.
- The efficacy of LAAC in hypertrophic cardiomyopathy (HCM) patients with AF is not well-established.
Purpose of the Study:
- To compare the risk of stroke in HCM patients with AF treated with LAAC versus those treated with anticoagulation (AC).
Main Methods:
- A real-world study using the TriNetX Global Research Network (2015-2024).
- HCM-AF patients were categorized into LAAC or AC groups and followed for 3 years.
- Propensity score matching was employed to control for confounding factors.
Main Results:
- Of 14,867 HCM-AF patients, 364 (2.5%) received LAAC and 14,503 (97.5%) received AC.
- After propensity score matching, LAAC patients showed higher rates of ischemic stroke (13% vs 8%) and systemic embolism (14% vs 9%) compared to AC patients.
- No significant difference in all-cause mortality was observed between the groups.
Conclusions:
- Real-world data suggest LAAC is not a primary strategy to reduce stroke risk in HCM-AF patients on long-term AC.
- LAAC may be a viable option for HCM-AF patients with prohibitive bleeding risk who cannot tolerate AC.
Background:
Percutaneous left atrial appendage closure (LAAC) is an effective alternative strategy for stroke prevention in patients with atrial fibrillation (AF) at high risk for bleeding with anticoagulation (AC). Efficacy of this strategy in hypertrophic cardiomyopathy (HCM) remains uncertain.
Objective:
The study aimed to compare risk of stroke in HCM-AF patients treated with LAAC with those treated with AC.
Methods:
By use of the TriNetX Global Research Network, HCM-AF patients from 2015 to 2024 were assigned to categories of treatment with LAAC and treatment solely with AC and observed for 3 years for ischemic stroke, systemic embolism, and all-cause mortality. Propensity score matching was used to limit confounders.
Results:
Of 14,867 HCM-AF patients identified, 364 (2.5%) were treated with LAAC vs 14,503 (97.5%) treated with AC. HCM LAAC patients were older (72 vs 67 years; P < .001) and had more comorbidities and more prior bleeding events, including higher rate of prior gastrointestinal bleeding (68% vs 18%; P < .001), compared with HCM patients treated solely with AC. After propensity score matching, there was no baseline difference between groups including prior bleeding events (P > .05). During follow-up, HCM patients treated with LAAC had higher rates of ischemic stroke (13% vs 8%; hazard ratio, 1.9; P = .006) and systemic embolism (14% vs 9%; hazard ratio, 1.8; P = .006) but no difference in mortality compared with matched HCM patients receiving AC.
Conclusion:
These real-world data do not support percutaneous LAAC in HCM-AF patients as the primary treatment strategy during long-term AC to reduce stroke risk. However, LAAC may remain a reasonable option for HCM-AF patients who are unable to tolerate AC because of prohibitive bleeding risk.
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