Left atrial appendage closure (LAAC) in patients at moderate to high risk for stroke who were undergoing catheter atrial fibrillation (AFib) ablation resulted in significantly less bleeding compared with oral anticoagulation, based on findings from the OPTION trial presented at AHA 2024 and simultaneously published in NEJM.

Researchers randomized 1,360 patients with AFib and an elevated CHA2DS2-VASc (male ≥2, female ≥3) to either ablation plus LAAC or ablation plus oral anticoagulation. LAAC was performed either concomitant with (40.8%) or sequentially after (59.2%) AFib ablation. The mean age of participants was 70 years and 34% were women. The primary efficacy endpoint was all-cause death, stroke, or systemic embolism at 36 months. The primary safety endpoint was non-procedure-related major bleeding or clinically relevant nonmajor bleeding.

At 36 months, a primary safety endpoint event had occurred in 65 patients (8.5%) in the LAAC group and in 137 patients (18.1%) in the anticoagulation group (p<0.001 for superiority). A primary efficacy endpoint event occurred in 41 patients (5.3%) undergoing LAAC and 44 patients (5.8%) receiving oral anticoagulation. Complications related to the appendage closure device or procedure occurred in 23 patients.

"The fact that LAAC can be completed safely at the time of AFib ablation makes it a possible alternative to long-term oral anticoagulation," said the authors. In presenting the findings, Oussama M. Wazni, MD, added that concomitant AFib ablation and LACC has the potential to reduce procedural risks and recovery times in patients. "In one procedure, we have the potential to decrease AFib burden and decrease the risk of stroke and leading," Wazni added.