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POSTOPERATIVE ATRIAL FIBRILLATION AND STROKE FOLLOWING LEFT ATRIAL APPENDAGE CLOSURE DURING ROUTINE CARDIAC SURGERY
716 JACC April 5, 2016 Volume 67, Issue 13
Arrhythmias and Clinical EP POSTOPERATIVE ATRIAL FIBRILLATION AND STROKE FOLLOWING LEFT ATRIAL APPENDAGE CLOSURE DURING ROUTINE CARDIAC SURGERY Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: Methods for Evaluation for Atrial Fibrillation Ablation and LAA Abstract Category: 16. Arrhythmias and Clinical EP: AF/SVT Presentation Number: 1117-343 Authors: Khalil Anouti, Waqas Qureshi, Mohammad El Baba, Marwan Refaat, Lankenau Medical Center, Wynnewood, PA, USA
Background: The left atrial appendage (LAA) is the most common source of thrombus resulting in stroke. Several percutaneous techniques for LAA occlusion have been recently proposed; including intracardiac plugs and external ligation. Only one device, WATCHMAN, has been compared to the standard therapy in randomized clinical trials. Mechanical approaches to LAA occlusion, on the other hand, have been used for more than half a century in cardiac surgery. It is not known if left atrial appendage closure during routine cardiac surgery leads to lower risk of stroke and postoperative atrial fibrillation (AF).
Methods: We systematically reviewed studies evaluating LAA closure during routine cardiac surgery and the risk of post procedure stroke or transient ischemic attack (TIA) and AF. We searched MEDLINE, CINAHL, Web of Science, meeting abstracts, presentations and Cochrane central databases from inception through June 2015. For a study to be selected, it had to report the rates of incident stroke and AF in individuals with and without LAA closure. Data were extracted by 2 independent authors. Forrest plot was created to show the effect sizes.
Results: A total of 11 studies including 16403 patients were analyzed. There were 3237 patients that underwent LAA closure and 13166 patients that did not undergo LAA closure. Over a mean follow up of 21.6 months, there were 65 (2.0%) stroke/TIA and 685 (21.9%) incident AF that occurred in LAA exclusion group, while 596 (4.5%) stroke/TIA and 2978 (31.9%) incident AF occurred in non LAA closure group. In a random effects model, there was a trend towards lower risk of stroke/TIA in individuals with LAA exclusion [pooled hazard ratio (95% confidence interval); 0.78 (0.60 - 1.01) p-value= 0.06] while there was no significant association of LAA closure with incident AF (p-value >0.71). Conclusions: In this meta-analysis of studies, LAA closure during routine cardiac surgery showed a trend towards lower risk of post procedure stroke/TIA but did not show an association with reduced risk of AF. Further trials are needed to show the long-term safety and effectiveness of prophylactic LAA closure during cardiac surgery as an effective alternative to anticoagulation in reducing stroke.
Arrhythmias and Clinical EP POSTOPERATIVE ATRIAL FIBRILLATION AND STROKE FOLLOWING LEFT ATRIAL APPENDAGE CLOSURE DURING ROUTINE CARDIAC SURGERY Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: Methods for Evaluation for Atrial Fibrillation Ablation and LAA Abstract Category: 16. Arrhythmias and Clinical EP: AF/SVT Presentation Number: 1117-343 Authors: Khalil Anouti, Waqas Qureshi, Mohammad El Baba, Marwan Refaat, Lankenau Medical Center, Wynnewood, PA, USA
Background: The left atrial appendage (LAA) is the most common source of thrombus resulting in stroke. Several percutaneous techniques for LAA occlusion have been recently proposed; including intracardiac plugs and external ligation. Only one device, WATCHMAN, has been compared to the standard therapy in randomized clinical trials. Mechanical approaches to LAA occlusion, on the other hand, have been used for more than half a century in cardiac surgery. It is not known if left atrial appendage closure during routine cardiac surgery leads to lower risk of stroke and postoperative atrial fibrillation (AF).
Methods: We systematically reviewed studies evaluating LAA closure during routine cardiac surgery and the risk of post procedure stroke or transient ischemic attack (TIA) and AF. We searched MEDLINE, CINAHL, Web of Science, meeting abstracts, presentations and Cochrane central databases from inception through June 2015. For a study to be selected, it had to report the rates of incident stroke and AF in individuals with and without LAA closure. Data were extracted by 2 independent authors. Forrest plot was created to show the effect sizes.
Results: A total of 11 studies including 16403 patients were analyzed. There were 3237 patients that underwent LAA closure and 13166 patients that did not undergo LAA closure. Over a mean follow up of 21.6 months, there were 65 (2.0%) stroke/TIA and 685 (21.9%) incident AF that occurred in LAA exclusion group, while 596 (4.5%) stroke/TIA and 2978 (31.9%) incident AF occurred in non LAA closure group. In a random effects model, there was a trend towards lower risk of stroke/TIA in individuals with LAA exclusion [pooled hazard ratio (95% confidence interval); 0.78 (0.60 - 1.01) p-value= 0.06] while there was no significant association of LAA closure with incident AF (p-value >0.71). Conclusions: In this meta-analysis of studies, LAA closure during routine cardiac surgery showed a trend towards lower risk of post procedure stroke/TIA but did not show an association with reduced risk of AF. Further trials are needed to show the long-term safety and effectiveness of prophylactic LAA closure during cardiac surgery as an effective alternative to anticoagulation in reducing stroke.