Percutaneous left atrial appendage closure has emerged as an effective alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation (AF). Two studies presented at AHA 2024 Scientific Sessions describe the efficacy and safety of left atrial appendage closure after catheter ablation for AF and the 5-year outcomes of the largest randomized left atrial appendage closure trial to date comparing the safety and efficacy of two devices.

In total, 803 patients (mean age 69.7 years; 35.2% women) were assigned to the left atrial appendage closure group and 797 patients (mean age 69.4 years; 33% women) to the anticoagulation therapy group. The left atrial appendage closure device (Watchman FLX; Boston Scientific) was implanted at the same time as the ablation procedure or in a sequential manner (90–180 days before randomization). At 36 months, a primary safety end point event (non-procedure-related major bleeding or clinically relevant non-major bleeding) occurred in 8.5% (n = 65) of the device group and 18.1% (n = 137) of the anticoagulation group (P < 0.001 for superiority). Furthermore, left atrial appendage closure was non-inferior to anticoagulation with respect to the composite efficacy end point of death from any cause, stroke or systemic embolism (P < 0.001). Together, these findings suggest that in patients at moderate or high risk of stroke, implantation of a left atrial appendage closure device at the same time as catheter ablation for AF might be an alternative to long-term oral anticoagulation.