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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous left atrial appendage closure for stroke prevention in atrial fibrillation: who should receive it in
Marc-André d'Entremont1,2,3, Jeff S Healy1,2, Sanjit S Jolly1,2
1Population Health Research Institute, McMaster University, Hamilton.
Insights
Percutaneous left atrial appendage closure (pLAAC) offers an alternative to oral anticoagulation for stroke prevention in atrial fibrillation patients. Ongoing trials may expand its use in various patient groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Oral anticoagulation (OAC) is standard for stroke prevention in atrial fibrillation but has limitations like bleeding and noncompliance.
- Percutaneous left atrial appendage closure (pLAAC) is an emerging alternative therapy.
- Understanding current and potential indications for pLAAC is crucial.
Purpose of the Study:
- To review current and potential indications for pLAAC in atrial fibrillation.
- To identify knowledge gaps in pLAAC therapy.
- To assess the evolving role of pLAAC in stroke prevention.
Main Methods:
- Review of current guidelines and clinical evidence for pLAAC.
- Analysis of ongoing randomized trials investigating pLAAC.
- Evaluation of pLAAC in specific patient populations.
Main Results:
- Current guidelines support pLAAC for high-stroke-risk atrial fibrillation patients with bleeding risk or OAC contraindications.
- pLAAC is under investigation for patients with end-stage renal disease, post-ablation, or those experiencing breakthrough events on OAC.
- The LAAOS-IV trial will compare pLAAC plus OAC versus OAC alone for stroke prevention.
Conclusions:
- pLAAC is increasingly utilized for atrial fibrillation patients with moderate-to-high stroke risk and OAC contraindications.
- Ongoing randomized trials are expected to broaden the application of pLAAC.
- Further research will define the optimal role of pLAAC in stroke prevention strategies.
Purpose Of Review:
Although oral anticoagulation (OAC) remains the cornerstone therapy for stroke prevention in atrial fibrillation, several limitations, such as noncompliance and bleeding, limit its effectiveness. Percutaneous left atrial appendage closure (pLAAC) has emerged as a promising therapy. We will review current and potential indications for pLAAC and knowledge gaps.
Recent Findings:
Current guidelines recommend pLAAC for patients who have atrial fibrillation at moderate to high risk of stroke with a high risk of bleeding or who have a contraindication for OAC. pLAAC is being investigated as a potential therapeutic option for the following patient populations: end-stage renal disease, after atrial fibrillation ablation, and in combination with OAC in patients with a high risk of breakthrough stroke or in patients with prior stroke on OAC. The Left Atrial Appendage Occlusion Study IV (LAAOS-IV) ( n = 4000) is a randomized trial that will determine the role of pLAAC and OAC compared to OAC alone in preventing ischemic stroke or systemic embolism.
Summary:
pLAAC has a growing role in patients with atrial fibrillation with moderate to high stroke risk and contraindication to OAC. Multiple randomized trials are currently underway in different patient populations, which may expand the role of pLAAC.
