Introduction:
Atrial fibrillation (AF) increases the risk of thromboembolic stroke. When anticoagulation for stroke prevention is contraindicated, left atrial appendage occlusion (LAAO) may be performed. Studies of LAAO have been limited by their small size, disparate patient populations, and lack of control group. To better understand the value of LAAO for prevention of stroke and systemic embolism, we performed a meta-analysis of studies evaluating the efficacy and safety of LAAO in non-valvular AF.
Methods:
A meta-analysis was performed of the safety and efficacy of LAAO in comparison with standard therapy for stroke prevention in non-valvular AF using random-effects modeling. Because only one trial had a control group comparing the efficacy of LAAO to standard therapy (warfarin), large outcomes data of stroke prevention were used to produce a hypothetical control group based on clinical variables in the individual studies (CHADS2 score). Results were stratified according to LAAO device type.
Results:
We identified 16 studies with a total of 1759 patients receiving LAAO. Summary estimates demonstrate LAAO reduced risk of stroke in comparison with no therapy or aspirin therapy (RR 0.34, 95% CI 0.25-0.46) and in comparison with warfarin therapy (RR 0.65, 95% CI 0.46-0.91, Figure). Summary estimates differed based on the study used to derive the hypothetical control group. Device deployment was unsuccessful in 6.1% of patients and overall complication rate was 7.1%. Efficacy and safety were similar across LAAO device type (Watchman, Plaato, Amplatzer cardiac plug, and Lariat). There was no significant heterogeneity between studies using the Cochrane Q statistic or the I2 index.
Conclusions:
Our data suggest that LAAO is a reasonable alternative to anticoagulation therapy. Data was limited with the use of most available devices. To better establish the risk and benefit of LAAO in comparison with standard therapy, more randomized controlled trials are necessary.
Efficacy and safety of left atrial appendage occlusion in atrial fibrillation patients with chronic kidney disease: a systematic review and meta-analysis
