Stroke prevention with left atrial appendage closure in high-risk, non-valvular atrial fibrillation patients complicated with coronary artery disease: a single-center retrospective study

Abstract

Objective Percutaneous left atrial appendage closure(LAAC)has been developed for stroke prevention for high-risk atrial fibrillation(AF)patients in recent years.For AF patients complicated with coronary artery disease(CAD), trpl anti-coagulation was related with high bleeding risk, thus we hypothesized that LAAC might yield benefit for its lower hemorrhagic risk compared to oral anticoagulants.This is a retrospective, single-center study aimed to investigate the safety and efficacy of LAAC in high-risk AF patients with coronary artery disease. Methods From May 2014 to November 2015, 36 AF patients with CAD underwent percutaneous LAAC operations at Wuhan Asia Heart Hospital.All CADs were confirmed by coronary angiography or coronary artery CTA.The clinical feature, LAA morphology, LAAC procedure and follow-up data of these patients were reviewed. Results Thirty-six patients were included, who were all high-risk NVAF patients complicated with stable CAD.The average CHA2DS2-VASc score was 2.94±1.43, and the average HAS-BLED score was 2.00 ±0.79.Successful left atrial appendage closures were achieved in all 36 patients.There was one case of ischemic stroke during peri-operative period, which responded well to drug therapy.During the 12 months of follow-up, there was no major bleeding or ischemic stroke/system embolism.33 patients completed TEE 45 days post-operative, which revealed 7 patients with residual flows of (2.67±1.50) mm, and 2 device-related thrombi, who continued anti-coagulatants.34 patients discontinued warfarin/dabigatran at 45 days after LAAC operations. Conclusion This study showed that percutaneous LAA closure could be performed as an effective and safe alternative for stroke prevention in high-risk NVAF patients complicated with stable CAD. Key words: Atrial fibrillation; Left atrial appendage closure; Coronary artery disease.