The Lead Episode 9: A Discussion of Left Atrial Appendage Occlusion in the Elderly-JACC: Clinical Electrophysiology

JACC: Clinical Electrophysiology

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This study aimed to compare the outcomes of left atrial appendage occlusion (LAAO) between patients aged 80 and patients aged 80 years. The study included patients from randomized trials and nonrandomized registries of the Watchman 2.5 device. The primary efficacy endpoint was a composite of cardiovascular/unknown death, stroke, or systemic embolism at 5 years. The study found that procedural complications at 7 days were similar in both age groups. The primary endpoint occurred in 12.0% of patients aged 80 and in 25.3% of patients aged 80, indicating that elderly patients derive similar benefits from LAAO as their younger counterparts. The study also found no interaction between age and treatment effect for any of the secondary outcomes, including death, stroke, and bleeding. The average treatment effects of LAAO compared to warfarin were similar in the elderly population compared to younger patients. The study concludes that age alone should not preclude the consideration of LAAO in otherwise suitable candidates. The findings of this study provide important insights for clinicians in managing stroke prevention in the elderly population. It highlights the safety and efficacy of LAAO in elderly patients and supports its consideration as an alternative to lifelong oral anticoagulation in selected patients with nonvalvular atrial fibrillation.

Keywords

left atrial appendage occlusion

LAAO

elderly patients

stroke prevention

procedural complications

treatment effect

secondary outcomes

warfarin

suitable candidates

nonvalvular atrial fibrillation