TOPLINE:

Left atrial appendage closure (LAAC) was infrequently performed in patients with atrial fibrillation (AF) who refused oral anticoagulants yet was associated with a reduced risk for the composite of cardiovascular death, stroke, or systemic embolism at 3 years; the procedure was proved to be safe and feasible.

METHODOLOGY:

• Researchers conducted a retrospective observational study to assess whether the LAAC procedure was effective, feasible, and safe for patients with AF who refused or could not take oral anticoagulants despite medical recommendations.
• They reviewed data of 2649 LAAC procedures performed in patients with AF across four European centres between January 2009 and December 2022.
• The analysis compared patients who underwent LAAC because they refused oral anticoagulants (refusal group) and those who underwent LAAC for established indications (control group).
• The main endpoint was a composite of cardiovascular death, stroke, or systemic embolism. Major bleeding, LAAC technical success, and procedural complications were also assessed.
• The observed rates of thromboembolic and major bleeding events were compared with those predicted by validated clinical risk scores for thromboembolism and bleeding.

TAKEAWAY:

• Of all LAAC procedures, 119 were done for the refusal group (mean age, 68.1 years; 35% women) and 238 were done for the control group (mean age, 75.0 years; 27% women).
• Patients in the refusal group had a lower risk for the composite of cardiovascular death, stroke, or systemic embolism than those in the control group (adjusted hazard ratio, 0.37; P = .048) over a mean follow-up duration of 3 years.
• An LAAC device was successfully implanted in more than 90% of patients in both groups, with no significant difference. Rates of procedural complications did not differ between the groups.
• Patients in the refusal group had annual thromboembolic and major bleeding rates of 2.3% and 1.9%, respectively — about 62% and 47%, respectively, lower than the rates predicted by validated scores.

IN PRACTICE:

"The ischemic outcomes rates at 3 years suggest a good efficacy of LAAC in preventing stroke in these patients," the researchers reported.

SOURCE:

This study was led by Roberto Galea, MD, Bern University Hospital, Bern, Switzerland. It was published online on September 25, 2025, in the Journal of the American Heart Association.

LIMITATIONS:

This study was observational and retrospective, which may have introduced bias and unmeasured confounders. A propensity-matched score analysis could not be performed due to incomplete data. The study outcomes were reported by investigators without independent adjudication.

DISCLOSURES:

This study did not receive any specific funding. One author reported receiving speaking honorarium from Boston Scientific and research grant from the Swiss Heart Foundation and serving as a proctor and consultant for Abbott. Several other authors reported receiving grants or speaker fees/honoraria from multiple organisations and companies making pharmaceutical or healthcare products and medical devices.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.