Left Atrial Appendage Occlusion in Patients With Prior Intracranial Hemorrhage

Area of Science:

• Cardiology
• Neurology
• Medical Devices

Background:

• Patients with atrial fibrillation (AF) and prior intracranial hemorrhage (ICH) face limited stroke prevention options due to trial exclusions and OAC resistance.
• Left atrial appendage occlusion (LAAO) offers a potential alternative for stroke risk reduction in this high-risk population.

Purpose of the Study:

• To evaluate the safety and efficacy of LAAO in patients with a history of ICH.
• To compare outcomes between patients with and without prior ICH undergoing LAAO.

Main Methods:

• Retrospective analysis of the National Cardiovascular Data Registry LAAO Registry (January 2016-September 2021).
• Comparison of outcomes between patients with prior ICH (Group 2) and those without (Group 1).
• Primary outcomes included combined ischemic stroke/TIA and ICH events.

Main Results:

• Group 2 (prior ICH) had higher CHA2DS2-VASc and HAS-BLED scores.
• Neurologic complications were more frequent in Group 2, though overall event rates were low.
• Adjusted analysis showed higher risks of stroke/TIA (HR 1.39) and ICH (HR 3.15) in Group 2.

Conclusions:

• LAAO is associated with increased neurologic complications in patients with prior ICH.
• Despite higher risks, LAAO demonstrates favorable event rates compared to similar patients not on OAC.
• LAAO presents a reasonable stroke prevention strategy for AF patients with a history of ICH.