An updated systematic review and meta-analysis of early outcomes after left atrial appendage occlusion.

MedStar author(s):
Citation: Journal of Interventional Cardiology. 2018 Mar 01Journal of Interventional Cardiology. 31(2):197-206, 2018 Apr.PMID: 29495123Institution: MedStar Washington Hospital CenterDepartment: Medicine/Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Atrial Appendage/su [Surgery] | *Atrial Fibrillation | *Septal Occluder Device | *Stroke | Atrial Fibrillation/co [Complications] | Atrial Fibrillation/su [Surgery] | Cardiovascular Surgical Procedures/mt [Methods] | Female | Humans | Male | Stroke/et [Etiology] | Stroke/pc [Prevention & Control] | Treatment OutcomeYear: 2018ISSN:
  • 0896-4327
Abstract: BACKGROUND: Left atrial appendage occlusion (LAAO) is a promising intervention for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Early outcomes following LAAO have been published in many studies with variable results.CONCLUSIONS: This meta-analysis concludes that LAAO occlusion is a safe and effective stroke prevention strategy in patients with NVAF.Copyright (c) 2018, Wiley Periodicals, Inc.METHODS: Medline/Pubmed, Ovid Journals, Clinical trials, Abstract meetings, Cochrane databases were searched from January 1st, 1999 to November 30th, 2016.OBJECTIVE: This updated meta-analysis aims to provide a summary of the early outcomes of LAAO.RESULTS: This meta-analysis included 49 studies involving 12415 patients. The median age was 73.5 years (IQR 72-75 years) and 43% were males. Hypertension and diabetes were present in 36% and 15% of the population, respectively. There was a prior history of stroke and congestive heart failure in 14% and 18% of the population, respectively. The median CHADS<sub>2</sub> score was 2.9 (IQR 2.6-3.3) and the median HASBLED score was 3.3 (IQR 3-4). LAAO implantation was successful in 96.3% of patients (95.40-97.08, I<sup>2</sup> =76.1%). The pooled proportion of all-cause mortality was 0.28% (0.19-0.38, I<sup>2</sup> =0%). The pooled proportion of all-cause stroke was 0.31% (0.22-0.42, I<sup>2</sup> =9.4%), major bleeding requiring transfusion was 1.71% (1.13-2.41, I<sup>2</sup> =73.2%), and pericardial effusion was 3.25% (2.46-4.14, I<sup>2</sup> =79%). Sub analysis of randomized clinical trials comparing LAAO devices to warfarin showed lower mortality (P=0.03) with similar bleeding risk (P=0.20) with LAAO.All authors: Kim J, Kolluru P, Lazkani M, Miryala V, Moole H, Morris M, Pershad A, Sawant AC, Yerasi CFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2018-04-20
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Journal Article MedStar Authors Catalog Article 29495123 Available 29495123

BACKGROUND: Left atrial appendage occlusion (LAAO) is a promising intervention for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Early outcomes following LAAO have been published in many studies with variable results.

CONCLUSIONS: This meta-analysis concludes that LAAO occlusion is a safe and effective stroke prevention strategy in patients with NVAF.

Copyright (c) 2018, Wiley Periodicals, Inc.

METHODS: Medline/Pubmed, Ovid Journals, Clinical trials, Abstract meetings, Cochrane databases were searched from January 1st, 1999 to November 30th, 2016.

OBJECTIVE: This updated meta-analysis aims to provide a summary of the early outcomes of LAAO.

RESULTS: This meta-analysis included 49 studies involving 12415 patients. The median age was 73.5 years (IQR 72-75 years) and 43% were males. Hypertension and diabetes were present in 36% and 15% of the population, respectively. There was a prior history of stroke and congestive heart failure in 14% and 18% of the population, respectively. The median CHADS<sub>2</sub> score was 2.9 (IQR 2.6-3.3) and the median HASBLED score was 3.3 (IQR 3-4). LAAO implantation was successful in 96.3% of patients (95.40-97.08, I<sup>2</sup> =76.1%). The pooled proportion of all-cause mortality was 0.28% (0.19-0.38, I<sup>2</sup> =0%). The pooled proportion of all-cause stroke was 0.31% (0.22-0.42, I<sup>2</sup> =9.4%), major bleeding requiring transfusion was 1.71% (1.13-2.41, I<sup>2</sup> =73.2%), and pericardial effusion was 3.25% (2.46-4.14, I<sup>2</sup> =79%). Sub analysis of randomized clinical trials comparing LAAO devices to warfarin showed lower mortality (P=0.03) with similar bleeding risk (P=0.20) with LAAO.

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