Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation

Abstract

Among patients with atrial fibrillation at high risk for stroke and bleeding, left atrial appendage closure was not noninferior to physician-directed best medical care with regard to a composite end point of stroke, systemic embolism, major bleeding, or cardiovascular or unexplained death. (Funded by the German Center for Cardiovascular Research; CLOSURE-AF ClinicalTrials.gov number, NCT03463317.).

What are the key findings of this study?

A study looks at two ways to prevent strokes in people with a heart condition called atrial fibrillation. One method is a procedure to close a part of the heart, and the other is to use medication. The results show that closing that part of the heart doesn't work better than just taking medicine. This finding is important because it helps doctors decide the best treatment for keeping patients safe. 🩺

Key Points

Objective

To evaluate whether left atrial appendage closure is noninferior to best medical care for stroke and associated risks in patients with atrial fibrillation.

Methods

Randomized controlled trial design
Involvement of patients at high risk for stroke and bleeding
Comparison of left atrial appendage closure with physician-directed medical therapy
Assessment of a composite endpoint including stroke, systemic embolism, major bleeding, and cardiovascular death

Results

Left atrial appendage closure did not show noninferiority to medical therapy for the composite endpoint.
No significant differences were observed in the incidences of stroke, systemic embolism, major bleeding, or cardiovascular death.
The findings imply that medical therapy remains an effective option for patients with atrial fibrillation.

What is the clinical evidence from this study?

Study Design

Other

Key Finding

Left atrial appendage closure was not noninferior to best medical care for a composite endpoint of stroke, bleeding, or cardiovascular death in high-risk atrial fibrillation patients.