Left Atrial Appendage Occlusion to Prevent Stroke: A Viable Alternative

A patient-level meta-analysis, the largest such comparison to date, suggests improved outcomes over warfarin in patients with nonvalvular AF.

With the recent FDA approval of the Watchman device, clinicians can consider left atrial appendage (LAA) occlusion to prevent stroke in patients with nonvalvular atrial fibrillation (AF). These researchers performed a patient-level meta-analysis of the two large studies (PROTECT-AF and PREVAIL) that formed the basis for the FDA approval, combined with two nonrandomized, continuing-access registries of these trials.

The meta-analysis covered 1877 LAA occlusion patients and 382 patients receiving warfarin alone. LAA occlusion recipients were treated with aspirin and warfarin for ≥45 days after device implantation. All patients were considered at high risk for stroke (estimated annual risk for stroke if untreated, 5.7%–7.6%).

Mean follow-up rang…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)