The New England Journal of MedicineLeft Atrial Appendage Closure after Ablation for Atrial Fibrillation

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The OPTION trial demonstrates that left atrial appendage closure (LAAC) following catheter ablation for atrial fibrillation provides comparable stroke prevention with reduced bleeding risk compared to oral anticoagulation. This international randomized trial of 1,600 patients with elevated CHA2DS2-VASc scores showed LAAC was superior in preventing non-procedure-related bleeding while maintaining non-inferiority for death, stroke, and systemic embolism over 36 months of follow-up.

Key Points:

• LAAC reduced non-procedure-related major or clinically relevant bleeding by 56% compared to oral anticoagulation (8.5% vs 18.1%, p<0.001)
• Primary efficacy outcomes (death, stroke, systemic embolism) were similar between LAAC and anticoagulation (5.3% vs 5.8%)
• Device implantation success rate was 98.8%, with complications in only 23 patients (2.9%)
• Complete left atrial appendage seal was achieved in 79.7% of LAAC patients at 12 months
• Ischemic stroke rates were comparable (1.2% LAAC vs 1.3% anticoagulation)

HCN Medical Memo
LAAC represents a viable alternative to long-term oral anticoagulation in post-ablation AF patients, offering reduced bleeding risk while maintaining equivalent stroke prevention.

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