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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation

Shephal K Doshi1,2, Saibal Kar3, Devi G Nair4

  • 1Cedars-Sinai Smidt Heart Institute, Los Angeles.

The New England Journal of Medicine
|March 30, 2026
PubMed

Insights

Left atrial appendage closure in atrial fibrillation patients was noninferior to NOAC therapy for preventing stroke and superior for reducing bleeding. This offers a safer alternative for stroke prevention in eligible patients.

Area of Science:

  • Cardiology
  • Medical Devices
  • Pharmacology

Background:

  • Oral anticoagulants for atrial fibrillation (AF) stroke prevention carry bleeding risks.
  • Left atrial appendage (LAA) closure is an alternative for patients unsuitable for anticoagulation.
  • The efficacy and safety of LAA closure in anticoagulation-eligible AF patients remain under investigation.

Purpose of the Study:

  • To compare the efficacy and safety of device-based LAA closure versus non-vitamin K antagonist oral anticoagulant (NOAC) therapy.
  • To evaluate LAA closure as an alternative to NOACs in AF patients eligible for anticoagulation.

Main Methods:

  • A prospective, international, randomized trial involving 3000 AF patients eligible for anticoagulation.
  • Patients were randomized 1:1 to LAA closure (device group) or NOAC therapy (anticoagulation group).
  • Primary efficacy endpoint: composite of cardiovascular death, stroke, or systemic embolism (3-year noninferiority). Primary safety endpoint: non-procedure-related bleeding (superiority).

Main Results:

  • At 3 years, the primary efficacy event occurred in 5.7% of the device group vs. 4.8% of the anticoagulation group (noninferior).
  • Non-procedure-related bleeding occurred in 10.9% of the device group vs. 19.0% of the anticoagulation group (superior).
  • The study included 3000 patients with a mean age of 71.7 years and a mean CHA2DS2-VASc score of 3.5.

Conclusions:

  • Device-based LAA closure is noninferior to NOAC therapy for preventing major adverse events in AF patients eligible for anticoagulation.
  • LAA closure demonstrated superior safety by significantly reducing non-procedure-related bleeding compared to NOACs.
  • LAA closure presents a viable and safer alternative for stroke prevention in select AF patients.
Abstract

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