Professor Jens Erik Nielsen-Kudsk
A large Danish study indicates that transcatheter left atrial appendage closure is just as effective as blood thinners to reduce the risk of stroke in patients with atrial fibrillation. Compared with anticoagulation, left atrial appendage closure markedly lowers the risk of bleeding and death.
In Denmark, approximately 120,000 patients suffer from atrial fibrillation and thus an increased risk of stroke. Atrial fibrillation may cause the blood to clot in the cone-shaped pouch of the left atrium in the heart called the left atrial appendage or left auricle. This can be effectively prevented by anticoagulants; however, the side effect of this type of medicine is a considerably increased risk of bleeding.
In recent years, a new treatment has been developed for patients at high risk of bleeding. By a percutaneous minimal intervention in local anaesthesia, cardiologists can close the left atrial appendage and seal it from the heart and circulation to prevent blood clots traveling from the left atrial appendage to the brain causing a stroke. A small closure device is introduced by a catheter inserted through the patient’s groin. The closure device is released and fixed in the left atrium of the heart.
A large study by researchers from Aarhus University Hospital in collaboration with researchers from Aalborg University Hospital in Denmark and universities in London and Essen have compared the results of transcatheter left atrial appendage closure and medical treatment.
Between June 2015 and September 2016, 1,071 patients with atrial fibrillation from all over the world underwent transcatheter left atrial appendage closure and results were compared with a group of Danish patients with atrial fibrillation treated by anticoagulants. The two groups were matched according to age and risk factors for stroke and bleeding.
- Markedly fewer patients suffered a stroke, major bleeding or death in the group undergoing transcatheter left atrial appendage closure compared with the group treated by anticoagulants and the difference between the groups increased during the two-year follow-up period, says professor Jens Erik Nielsen-Kudsk.
Overall, the prevalence of stroke, major bleeding and death was 43% lower in the group undergoing transcatheter left atrial appendage closure. The risk of bleeding was 38% lower and mortality was 47% lower in this group. The prevalence of stroke was low and almost similar in both groups – presumably because both treatments are effective to prevent stroke.
- The study indicates that transcatheter left atrial appendage closure is just as effective to prevent stroke as anticoagulant treatment; however, transcatheter left atrial appendage closure is superior to avoid bleeding and death, says Jens Erik Nielsen-Kudsk.
Researchers recommend that the results are confirmed in a clinical trial where patients with atrial fibrillation are randomised to either undergo transcatheter left atrial appendage closure or receive anticoagulant treatment.
Behind the research result:
Type of study: Propensity-score matched registry study
Collaborators: Aalborg University Hospital, Denmark, Universität Duisburg-Essen, Germany and St. George's University of London, England.
External financing: Novo Nordic Foundation
Conflicts of interest: Jens Erik Nielsen-Kudsk is investigator and proctor at Abbott, Boston Scientific
Read the scientific article:
Jens Erik Nielsen-Kudsk, Kasper Korsholm, Dorte Damgaard, Jan Brink Valentin, Hans-Christoph Diener, Alan John Camm, Søren Paaske Johnsen. Clinical Outcomes Associated with Transcatheter Left Atrial Appendage Occlusion vs Direct Oral Anticoagulation in High-Risk Atrial Fibrillation Patients. J Am Coll Cardiol Cardiovasc Interv. 2021, Jan, 14 (1) 69–78; doi: https://www.jacc.org/doi/10.1016/j.jcin.2020.09.051
Results have been presented as a late-breaking trial at a hot-line session at the annual European congress for interventional cardiologists (EuroPCR) 27 June 2020, which was held as an PCR e-Course due to the COVID-19 pandemic.
Jens Erik Nielsen-Kudsk, Consultant, Professor
Aarhus University Hospital, Department of Cardiology and
Aarhus University, Department of Clinical Medicine
Tel.: +45 3092 2341