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Updated: Jun 5, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage closure in patients with failure of anticoagulation therapy: A multicenter comparative study on
Alberto Preda1, Giulio Falasconi1, Francesco Melillo2
1De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, 20162 Milan, Italy.
Insights
Direct oral anticoagulants (DOACs) showed better outcomes than vitamin K antagonists (VKAs) in non-valvular atrial fibrillation patients after left atrial appendage closure (LAAC). This combination therapy reduces the risk of stroke and bleeding events.
Area of Science:
- Cardiology
- Internal Medicine
- Pharmacology
Background:
- Patients with non-valvular atrial fibrillation (nvAF) experiencing cardioembolic (CE) events despite oral anticoagulation (OAC) face high recurrence risk.
- Percutaneous left atrial appendage closure (LAAC) combined with long-term OAC is a potential strategy for these high-risk patients.
Purpose of the Study:
- To compare the safety and efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) following LAAC in nvAF patients with OAC failure.
- To evaluate the long-term outcomes of different anticoagulation strategies in this specific patient population.
Main Methods:
- Retrospective analysis of 132 nvAF patients from three Italian centers who underwent LAAC due to OAC failure.
- Patients were categorized into two groups: those on DOACs and those on VKAs post-LAAC.
- Primary endpoint: composite of all-cause death, CE event, and major bleeding. Secondary endpoint: composite of CE event and major bleeding.
Main Results:
- The DOAC group (73 patients) showed a significantly lower rate of the primary endpoint (HR 0.42) and secondary endpoint (HR 0.28) compared to the VKA group (59 patients) at a median follow-up of 61 months.
- No significant differences were observed based on the specific type of DOAC used.
- Predictors for the primary endpoint included prior cerebrovascular events, CHA2DS2-VASc, CHADS2, HAS-BLED scores, and renal dysfunction.
Conclusions:
- Long-term use of DOACs after LAAC in nvAF patients with OAC failure is associated with improved outcomes.
- DOACs demonstrated a higher rate of freedom from primary and secondary endpoints compared to VKAs in this high-risk cohort.
Background:
Patients with non-valvular atrial fibrillation (nvAF) who experienced a cardioembolic (CE) event despite adequate oral anticoagulation (OAC) are at high risk of recurrence and the combination between percutaneous left atrial appendage closure (LAAC) and long-term OAC may be a valuable option. The aim of this study was to compare the safety and the efficacy of post-LAAC long-term assumption of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) in this population.
Methods:
Consecutive nvAF patients who experienced OAC failure despite adequate OAC therapy and underwent LAAC were retrospectively enrolled from three Italian centers. Patients were divided according to the anticoagulation strategy following LAAC: DOAC group and VKA group. The primary endpoint was a composite of all-cause death, CE event, and major bleeding, while secondary endpoint was a composite of CE event and major bleeding.
Results:
Overall, 132 patients (39 % females; mean age 69 ± 11 years), including 73 patients on DOAC and 59 patients on VKA, were enrolled. At a median follow up of 61 ± 23 months, the DOAC group reported lower rate of primary endpoint (HR 0.42, 95 %CI 0.18-0.99, p = 0.038) and lower rate of secondary endpoint (HR 0.28, 95 %CI 0.09-0.89, p = 0.02). No significant differences were detected regarding the type of DOAC assumed. Previous cerebrovascular events, CHA2DS2-VASc, CHADS2, HAS-BLED, and renal dysfunction were predictors of the primary endpoint.
Conclusion:
Long-term DOAC assumption was associated with higher free from primary and secondary endpoint with respect to VKA in nvAF patients undergoing LAAC for OAC failure.
