Arrhythmias & electrophysiology
Management strategies to prevent stroke in patients with atrial fibrillation and malignant left atrial appendage
Authors' conclusion
Combination performing LAAC and continuation of OAC may be options to prevent ischemic stroke in patients with high thromboembolic risk and malignant LAA.
Study context
- Population
- Patients with AF; malignant left atrial appendage (LAA) = history of ischemic stroke and/or LAA thrombus despite continuous oral anticoagulation (OAC) (≥3 weeks)
- Participants
- 80 / 44 / 114
- Exposure
- LAA closure (LAAC) vs OAC alone in malignant LAA; malignant vs non-malignant LAA among LAAC
- Malignant LAA, LAACn = 80
- Malignant LAA, OAC alonen = 44reference
- Non-malignant LAA, LAACn = 114reference
- Outcome
- Ischemic stroke, 1-year cumulative incidence
- Follow-up
- 1 year
Main finding
As reported in the abstract
- All disabling strokes in malignant LAA treated with LAAC occurred only while not receiving OAC
- Malignant LAA, LAAC vs Malignant LAA, OAC alone: P = 0.09
- Malignant LAA, LAAC vs Malignant LAA, OAC alone: P = 0.84
- Malignant LAA, LAAC vs Non-malignant LAA, LAAC: P = 0.009
- Malignant LAA, LAAC vs Non-malignant LAA, LAAC: P = 0.11
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Ischemic stroke due to device-related thrombosis · 1 yearMalignant LAA, LAAC vs Non-malignant LAA, LAAC · 2.2% vs 0%; log-rank | P = 0.04 |
Original publication
Management strategies to prevent stroke in patients with atrial fibrillation and malignant left atrial appendage. Heart Rhythm. Published 8 November 2024. doi:10.
Summarised from the published abstract; every number is checked against it