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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Management strategies to prevent stroke in patients with atrial fibrillation and malignant left atrial appendage

Ryuki Chatani1, Shunsuke Kubo1, Hiroshi Tasaka1

  • 1Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.

Heart Rhythm
|November 9, 2024
PubMed

Insights

Patients with malignant left atrial appendage (LAA) and atrial fibrillation may benefit from left atrial appendage closure (LAAC). Combining LAAC with oral anticoagulation (OAC) may prevent ischemic stroke in high-risk individuals.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Thrombosis Research

Background:

  • Atrial fibrillation (AF) patients with malignant left atrial appendage (LAA) present a therapeutic challenge.
  • Limited evidence exists for left atrial appendage closure (LAAC) in this high-risk population.

Purpose of the Study:

  • To evaluate management strategies and clinical outcomes for patients with AF and malignant LAA.
  • To compare LAAC versus oral anticoagulation (OAC) alone in malignant LAA.
  • To compare malignant LAA patients undergoing LAAC versus non-malignant LAA patients undergoing LAAC.

Main Methods:

  • Malignant LAA defined by ischemic stroke history or LAA thrombus despite continuous OAC (≥3 weeks).
  • Study included 80 patients with malignant LAA treated with LAAC, compared against 44 malignant LAA patients on OAC alone.
  • Second comparison: 80 malignant LAA patients treated with LAAC versus 114 non-malignant LAA patients treated with LAAC.

Main Results:

  • LAAC for malignant LAA showed a trend towards higher 1-year ischemic stroke rates versus OAC alone (6.3% vs 5.3%, P=.09).
  • Disabling strokes in LAAC malignant LAA group occurred only when OAC was not administered.
  • Malignant LAA patients undergoing LAAC had higher 1-year ischemic stroke rates (device-related thrombosis included) than non-malignant LAA patients (6.3% vs 2.2%, P=.009).

Conclusions:

  • LAAC combined with continued OAC may be a viable strategy to prevent ischemic stroke in high-risk patients with malignant LAA.
  • Careful consideration of OAC status is crucial for stroke prevention in malignant LAA patients undergoing LAAC.
Abstract

Keywords:
Anticoagulation regimenAtrial fibrillationIschemic strokeLeft atrial appendage closureLeft atrial appendage thrombusMalignant left atrial appendageWatchman

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