In the Journals

Stroke risk increases after electrical LAA isolation

Luigi Di Biase

Electrical isolation of the left atrial appendage increased the risk for stroke, which can be reduced with left atrial appendage occlusion or uninterrupted oral anticoagulation, according to a study published in the Journal of the American College of Cardiology.

Luigi Di Biase, MD, PhD, FACC, FHRS, section head of electrophysiology, director of arrhythmia services and professor of medicine (cardiology) at Albert Einstein College of Medicine at Montefiore Hospital in New York, and colleagues analyzed data from 1,854 patients who underwent left atrial appendage (LAA) electrical isolation and remained in normal sinus rhythm at 6 months.

LAA function was assessed by transesophageal echocardiography 6 months after ablation. Three parameters were considered when categorizing LAA function as normal (n = 336; mean age, 64 years; 72% men) or abnormal (n = 1,518; mean age, 65 years; 76% men): LAA contractility, consistent A waves and LAA velocity.

All patients with normal LAA function discontinued oral anticoagulation after ablation regardless of their CHA2DS2-VASc score. In contrast, 432 patients were off oral anticoagulation and 1,086 remained on the therapy.

During a median follow-up of 2.3 years, there were no stroke events in patients with normal LAA function. Stroke or transient ischemic attack occurred in 1.7% of patients with abnormal LAA function who remained on oral anticoagulation and in 16.7% of patients who were no longer taking oral anticoagulation (P < .001).

The majority of patients who had a stroke or TIA (93.3%) were treated with an occlusion or LAA exclusion device. At a median follow-up of 12.4 months of device implantation, 2.4% of patients remained on oral anticoagulation due to personal preference or high stroke risk. The remaining patients (n = 81) were no longer taking oral anticoagulation and were taking low-dose aspirin.

“LAA [electrical isolation] should be considered a risk factor for stroke, and consequently, strict stroke prevention strategies are warranted for these patients,” Di Biase and colleagues wrote. “Furthermore, in this population, LAA closure strategy allowed safe anticoagulation discontinuation in a small group of patients.” – by Darlene Dobkowski

Disclosures: Di Biase reports he served as a consultant for Biosense Webster, Boston Scientific, Stereotaxis and St. Jude Medical and received speaker honoraria/travel support from Biosense Webster, Biotronik, Boston Scientific, Bristol-Byers Squibb, Medtronic, Pfizer and St. Jude Medical. Please see the study for all other authors’ relevant financial disclosures.

Luigi Di Biase

Electrical isolation of the left atrial appendage increased the risk for stroke, which can be reduced with left atrial appendage occlusion or uninterrupted oral anticoagulation, according to a study published in the Journal of the American College of Cardiology.

Luigi Di Biase, MD, PhD, FACC, FHRS, section head of electrophysiology, director of arrhythmia services and professor of medicine (cardiology) at Albert Einstein College of Medicine at Montefiore Hospital in New York, and colleagues analyzed data from 1,854 patients who underwent left atrial appendage (LAA) electrical isolation and remained in normal sinus rhythm at 6 months.

LAA function was assessed by transesophageal echocardiography 6 months after ablation. Three parameters were considered when categorizing LAA function as normal (n = 336; mean age, 64 years; 72% men) or abnormal (n = 1,518; mean age, 65 years; 76% men): LAA contractility, consistent A waves and LAA velocity.

All patients with normal LAA function discontinued oral anticoagulation after ablation regardless of their CHA2DS2-VASc score. In contrast, 432 patients were off oral anticoagulation and 1,086 remained on the therapy.

During a median follow-up of 2.3 years, there were no stroke events in patients with normal LAA function. Stroke or transient ischemic attack occurred in 1.7% of patients with abnormal LAA function who remained on oral anticoagulation and in 16.7% of patients who were no longer taking oral anticoagulation (P < .001).

The majority of patients who had a stroke or TIA (93.3%) were treated with an occlusion or LAA exclusion device. At a median follow-up of 12.4 months of device implantation, 2.4% of patients remained on oral anticoagulation due to personal preference or high stroke risk. The remaining patients (n = 81) were no longer taking oral anticoagulation and were taking low-dose aspirin.

“LAA [electrical isolation] should be considered a risk factor for stroke, and consequently, strict stroke prevention strategies are warranted for these patients,” Di Biase and colleagues wrote. “Furthermore, in this population, LAA closure strategy allowed safe anticoagulation discontinuation in a small group of patients.” – by Darlene Dobkowski

Disclosures: Di Biase reports he served as a consultant for Biosense Webster, Boston Scientific, Stereotaxis and St. Jude Medical and received speaker honoraria/travel support from Biosense Webster, Biotronik, Boston Scientific, Bristol-Byers Squibb, Medtronic, Pfizer and St. Jude Medical. Please see the study for all other authors’ relevant financial disclosures.