Patients having undergone left atrial appendage electrical isolation (LAAEI) were found to be at significantly increased risk for stroke, but this risk can be reduced by optimal uninterrupted oral anticoagulation (OAC) or implantation of a left atrial appendage occlusion (LAAO) device, according to results of a study published in the Journal of the American College of Cardiology.
The study included participants post-LAAEI who underwent follow-up transesophageal echocardiography (TEE) performed in sinus rhythm at 6 months to assess LAA function (n=1854). The researchers classified participants into 2 groups based on LAA functional parameters determined at the 6-month TEE: those with preserved LAA velocity (>0.4 m/s), preserved contractility, and consistent A waves, and those with 1 or more impaired LAA functions (velocity/contractility/ consistency of A-wave). The researchers then evaluated the incidence of thromboembolic events occurring in individuals following LAAEI “on” and “off” OAC.
The researchers found that 18% (n=336) of participants had preserved LAA velocity, contractility, and consistent A waves identified on TEE at 6 months. The remaining participants (n=1518) had abnormal parameters. All participants with preserved LAA function were off OAC in the post-ablation period, while 1086 of those with abnormal LAA contractility remained on OAC.
At long-term follow-up, participants with normal LAA function were not found to have had any stroke events. A 1.7% incidence of stroke/transient ischemic attack was noted in participants with abnormal LAA contractility who remained on OAC (n=18) compared with a 16.7% incidence in those who were off OAC (n=72).
Out of the 90 participants with stroke, 84 underwent implantation of an LAAO device. After a median of 12.4 months following device implantation, 81 participants discontinued OAC without any thromboembolic events while 2 remained on OAC due to high stroke risk or personal preference.
The study included several limitations. The researchers noted that the safety of LAAEI under optimal anticoagulation needs to be further evaluated in randomized trials, and discontinuing OAC based on LAA function is not standard practice.
“LAAEI should be considered a risk factor for stroke, and consequently, strict stroke prevention strategies are warranted for these patients,” the researchers wrote.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Di Biase L, Mohanty S, Trivedi C, et al. Stroke risk in patients with atrial fibrillation undergoing electrical isolation of the left atrial appendage. J Am Coll Cardiol. 2019;74(8):1020-1028.