To Lower Stroke Risk in Patients Undergoing Atrial Fibrillation Ablation, Is a Device or a Medication Better?

Multiple trials have shown that left atrial appendage occlusion has efficacy similar to oral coagulation (typically warfarin) in patients at elevated stroke risk. Whether this approach is effective in patients undergoing ablation of atrial fibrillation (AF) was tested in an industry-sponsored trial (NCT03795298).

The 1600 patients (mean age, 70; mean CHA₂Ds₂-VASc score, 3.5; nonwarfarin anticoagulant, 95%) received AF ablation and were randomized to oral anticoagulation or left atrial appendage occlusion with a device (Watchman). Device recipients continued anticoagulation for 3 months and aspirin for a year.

At 3-year follow-up, results were as follows:

• Rates of major or clinically relevant nonprocedural bleeding (the primary safety endpoint)…