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

By I Willits et al

This single-arm study has reported the results of the real-world safety and efficacy of LAAO from a multicentre, prospective, observational registry, with patient selection and treatment reflecting UK practice within the NHS of England. It is the largest study performed on LAAO in the UK to date. The results of this registry partly informed NHS England’s decision to commission LAAO routinely. In a cohort of 537 procedures, successful implantation of the LAAO device (in the absence of major complications) was achieved in 88.9% (95% CI 85.8–91.5) of patients. There were no significant improvements in the reported HRQoL, and no significant improvement in overall patient health (via visual analogue scale) beyond 6 weeks. The proportion free of ischaemic neurological events at 1 year was 96.7 % (95% CI 95.0–98.4). Five patients (1.0%) died in hospital.

This was the largest study to date on the safety and efficacy of LAAO in a UK NHS setting. The results show that LAAO is successfully implanted in about 90% of patients in whom it is attempted, which is consistent with other studies. The incidence of thromboembolic events was numerically lower compared with historic data from epidemiological studies (CHADS2 and CHA2DS2-VASc scores, although these are not directly comparable). The results support the view, consistent with the 2020 European Heat Rhythm Association/European Association of Percutaneous Cardiovascular Interventions (EHRA/EAPCI) consensus statement, that LAAO is an appropriate option to reduce the risk of ischaemic stroke in people with AF for whom oral anticoagulation is contraindicated or carries a high risk of bleeding. Further comparative research is warranted to understand the full extent of the protection afforded by LAAO in patients unable to take anticoagulants.

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Iain Willits, Kim Keltie, Nicholas Linker, Mark de Belder, Robert Henderson, Hannah Patrick, Helen Powell, Lee Berry, Samuel G Urwin, Helen Cole, Andrew J Sims, Left atrial appendage occlusion in the UK: prospective registry and data linkage to Hospital Episode Statistics, European Heart Journal – Quality of Care and Clinical Outcomes, 2021;, qcab042, https://doi.org/10.1093/ehjqcco/qcab042