Long-term outcomes of left atrial appendage closure techniques on stroke prevention of recurrent atrial fibrillation patients: epicardial excision versus percutaneous occlusion

TL;DR

This study compares two methods for preventing strokes in patients with recurring atrial fibrillation, finding that one method may significantly reduce stroke risk.

Contribution

The study provides new evidence comparing two left atrial appendage closure techniques for stroke prevention in atrial fibrillation patients.

Findings

LAAC-EE showed significantly greater stroke-free survival compared to LAAC-PO over 5 years.

Age and HAS-BLED score were significant predictors of stroke risk.

LAAC-EE may reduce stroke risk by approximately 51.6% compared to LAAC-PO.

Abstract

This study aimed to compare the efficacy of left atrial appendage closure performed by excision (LAAC-EE) vs. occlusion (LAAC-PO) for stroke prevention in patients with recurrent atrial fibrillation undergoing radiofrequency ablation.

In this retrospective analysis, 160 consecutive patients (109 undergoing LAAC-EE and 51 undergoing LAAC-PO) were evaluated. To adjust for baseline differences, stabilized inverse probability of treatment weighting (IPTW) was applied using a logistic regression model with age, sex, and CHA₂DS₂-VASc score as predictors. Weighted Kaplan–Meier survival analyses were conducted to assess stroke-free survival over a 5-year follow-up period, and weighted Cox proportional hazards regression was used to evaluate the association between LAAC modality and stroke occurrence, adjusting for age, sex, diabetes, CHA₂DS₂-VASc score, HAS-BLED score, and left atrium size.

Overall, the weighted mean CHA2DS2-VASc score was 3.1 ± 0.1 (3.0 ± 0.2 in LAAC-EE vs. 3.3 ± 0.2 in LAAC-PO; p = 0.159), indicating moderate baseline stroke risk. When stratified, 39.2% of LAAC-EE and 18.9% of LAAC-PO patients were in the low-risk category (CHA2DS2-VASc ≤2), 48.2% vs. 69.6% in the medium-risk group (score 3–4), and 12.6% vs. 11.5% in the high-risk group (score ≥5) (p = 0.093). Over 5 years, stroke occurred in 64 patients—29.4% in the LAAC-EE group vs. 62.7% in LAAC-PO—and weighted Kaplan–Meier analysis showed significantly greater stroke-free survival with excision (log-rank p < 0.001). In the weighted multivariate Cox model, LAAC-EE was associated with a non-significant 51.6% reduction in stroke risk (HR 0.48; 95% CI 0.13–1.74; p = 0.27). Age (HR 1.09 per year; p = 0.008) and HAS-BLED score (HR 10.54; p < 0.001) remained significant predictors, whereas sex, diabetes, and CHA₂DS₂-VASc score did not.

Although the multivariate analysis did not achieve statistical significance for the treatment modality, the observed hazard ratio indicates that LAAC-EE may reduce stroke risk by approximately 51.6% compared to LAAC-PO. The significant impact of age and HAS-BLED score on stroke risk underscores the importance of individualized patient selection. These findings suggest a potential clinical benefit of LAAC-EE, particularly among lower-risk patients, and warrant further investigation in larger prospective studies.

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