Cardiology Update, 12.9.24

Five critical care-adjacent RCTs alter the cardiac device/procedure landscape

Ablation with left atrial closure for atrial fibrillation (OPTION trial)

Catheter ablation can improve atrial fibrillation and its symptoms, but any reduction of stroke risk it might bring is unclear. Current guidelines recommend continuing anticoagulation indefinitely for patients at moderate or high stroke risk, even after successful ablation.

Many clots form in the left atrial appendage; catheter-based closure can prevent strokes by sealing off this part of the heart with a device (Watchman™, PLAATO™, et al). Although LAAC compares favorably to lifelong warfarin, there is limited data on its outcomes relative to treatment with newer anticoagulants.

Among 1600 patients undergoing ablation for atrial fibrillation randomized to either left atrial appendage closure or anticoagulant therapy (with a mean CHADS-VASc score of 3.5), those undergoing LAAC experienced far fewer bleeding complications (8.5% of the time vs 18.1% in the anticoagulation group) after 3 years.