Original Title: LAA occlusion vs. standard care in patients with atrial fibrillation and intracerebral hemorrhage – A propensity score matched follow-up study.
Presenter: Jens Erik Nielsen-Kudsk
Patients with atrial fibrillation and a history of intracerebral hemorrhage, have an elevated risk of both ischemic and hemorrhagic stroke.
There is no consensus on how to treat this kind of patients since the necessary anticoagulation required by atrial fibrillation will increase the risk of a new intracerebral hemorrhage. Percutaneous occlusion of the left atrial appendage (LAA) could be beneficial for this group of patients.
This study used propensity score to match bleeding and ischemic risk between the group receiving LAA closure and the group receiving medical treatment. The LAA group included 172 patients treated between 2009 and 2015 with Amplatzer Cardiac Plug (ACP) and Amplatzer Amulet (St. Jude Medical) closure devices. The control group included 784 patients with atrial fibrillation and intracerebral bleeding that had survived hospitalization for bleeding at least 180 days between 2005 and 2014.
Procedural success was 97.7% with 4% complications (1 hematemesis, 3 access vessel bleeding, 1 device migration and 1 pericardial effusion). Mean follow up was 166 days. Patients with atrial fibrillation and a history of intracerebral bleeding receiving LAA closure had lower risk of combined events (RR 0.19), lower mortality (RR 0.08), lower minor stroke (RR 0.35) and lower minor bleeding (RR 0.39).
Conclusion
Data in the study suggest that LAA closure can be beneficial for this population of patients with atrial fibrillation and a history of intracerebral hemorrhage. A randomized clinical study (STROKECLOSE) will be started with year to confirm these outcomes.
