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Left atrial appendage occlusion in the UK: prospective registry and data linkage to Hospital Episode Statistics

AIMS: Non-valvular atrial fibrillation (AF) greatly increases the risk of ischaemic stroke. For people with contraindications to oral anticoagulation, left atrial appendage occlusion (LAAO) provides a non-pharmacological management alternative. The aim of this study was to measure the procedural saf...

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Autores principales: Willits, Iain, Keltie, Kim, Linker, Nicholas, de Belder, Mark, Henderson, Robert, Patrick, Hannah, Powell, Helen, Berry, Lee, Urwin, Samuel G, Cole, Helen, Sims, Andrew J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8445086/
https://www.ncbi.nlm.nih.gov/pubmed/34097038
http://dx.doi.org/10.1093/ehjqcco/qcab042
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author Willits, Iain
Keltie, Kim
Linker, Nicholas
de Belder, Mark
Henderson, Robert
Patrick, Hannah
Powell, Helen
Berry, Lee
Urwin, Samuel G
Cole, Helen
Sims, Andrew J
author_facet Willits, Iain
Keltie, Kim
Linker, Nicholas
de Belder, Mark
Henderson, Robert
Patrick, Hannah
Powell, Helen
Berry, Lee
Urwin, Samuel G
Cole, Helen
Sims, Andrew J
author_sort Willits, Iain
collection PubMed
description AIMS: Non-valvular atrial fibrillation (AF) greatly increases the risk of ischaemic stroke. For people with contraindications to oral anticoagulation, left atrial appendage occlusion (LAAO) provides a non-pharmacological management alternative. The aim of this study was to measure the procedural safety and longer-term effectiveness of LAAO for AF in a UK setting. METHODS AND RESULTS: This was a prospective, single-armed registry of patients with AF for whom anticoagulation was unsuitable. Registry data were collected between October 2014 and April 2018 and linked to routine data sources for follow-up. Data from 583 LAAO procedures were entered into the registry, of which 537 (from 525 patients) were eligible for inclusion (median CHA(2)DS(2)-VASc score 4). A closure device was successfully implanted in 93.4% of cases, with a procedural success rate (device implanted without major complication) of 88.9%. Five patients (1.0%) died in hospital. During follow-up [median 729 (Q1:Q3, 523:913) days] 45 patients experienced neurological events; 33 of which were ischaemic. The ischaemic neurological event rate was 3.3 (1.6–5.0)% at 1 year (n = 387) and 7.0 (4.3–9.6)% at 2 years (n = 196). There were significant improvements in overall patient health (via Visual Analogue Scale) measured at 6 weeks and 6 months, but no significant improvements observed in patient utility over time. CONCLUSION: The findings of our study suggest that LAAO is not without procedural risk, but that this risk may be justified in high-risk patients with AF who cannot take an anticoagulant. Moreover, the data do not provide support for more widespread use of LAAO as the complication rate was relatively high and would be difficult to justify in many patients with AF who tolerate anticoagulation.
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spelling pubmed-84450862021-09-17 Left atrial appendage occlusion in the UK: prospective registry and data linkage to Hospital Episode Statistics Willits, Iain Keltie, Kim Linker, Nicholas de Belder, Mark Henderson, Robert Patrick, Hannah Powell, Helen Berry, Lee Urwin, Samuel G Cole, Helen Sims, Andrew J Eur Heart J Qual Care Clin Outcomes Original Article AIMS: Non-valvular atrial fibrillation (AF) greatly increases the risk of ischaemic stroke. For people with contraindications to oral anticoagulation, left atrial appendage occlusion (LAAO) provides a non-pharmacological management alternative. The aim of this study was to measure the procedural safety and longer-term effectiveness of LAAO for AF in a UK setting. METHODS AND RESULTS: This was a prospective, single-armed registry of patients with AF for whom anticoagulation was unsuitable. Registry data were collected between October 2014 and April 2018 and linked to routine data sources for follow-up. Data from 583 LAAO procedures were entered into the registry, of which 537 (from 525 patients) were eligible for inclusion (median CHA(2)DS(2)-VASc score 4). A closure device was successfully implanted in 93.4% of cases, with a procedural success rate (device implanted without major complication) of 88.9%. Five patients (1.0%) died in hospital. During follow-up [median 729 (Q1:Q3, 523:913) days] 45 patients experienced neurological events; 33 of which were ischaemic. The ischaemic neurological event rate was 3.3 (1.6–5.0)% at 1 year (n = 387) and 7.0 (4.3–9.6)% at 2 years (n = 196). There were significant improvements in overall patient health (via Visual Analogue Scale) measured at 6 weeks and 6 months, but no significant improvements observed in patient utility over time. CONCLUSION: The findings of our study suggest that LAAO is not without procedural risk, but that this risk may be justified in high-risk patients with AF who cannot take an anticoagulant. Moreover, the data do not provide support for more widespread use of LAAO as the complication rate was relatively high and would be difficult to justify in many patients with AF who tolerate anticoagulation. Oxford University Press 2021-06-07 /pmc/articles/PMC8445086/ /pubmed/34097038 http://dx.doi.org/10.1093/ehjqcco/qcab042 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Willits, Iain
Keltie, Kim
Linker, Nicholas
de Belder, Mark
Henderson, Robert
Patrick, Hannah
Powell, Helen
Berry, Lee
Urwin, Samuel G
Cole, Helen
Sims, Andrew J
Left atrial appendage occlusion in the UK: prospective registry and data linkage to Hospital Episode Statistics
title Left atrial appendage occlusion in the UK: prospective registry and data linkage to Hospital Episode Statistics
title_full Left atrial appendage occlusion in the UK: prospective registry and data linkage to Hospital Episode Statistics
title_fullStr Left atrial appendage occlusion in the UK: prospective registry and data linkage to Hospital Episode Statistics
title_full_unstemmed Left atrial appendage occlusion in the UK: prospective registry and data linkage to Hospital Episode Statistics
title_short Left atrial appendage occlusion in the UK: prospective registry and data linkage to Hospital Episode Statistics
title_sort left atrial appendage occlusion in the uk: prospective registry and data linkage to hospital episode statistics
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8445086/
https://www.ncbi.nlm.nih.gov/pubmed/34097038
http://dx.doi.org/10.1093/ehjqcco/qcab042
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