ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1601303
Long-Term Outcomes of Left Atrial Appendage Closure Techniques on Stroke Prevention of Recurrent Atrial Fibrillation Patients: Epicardial Excision Versus Percutaneous Occlusion
Provisionally accepted
- Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Objective: This study aimed to compare the efficacy of left atrial appendage closure performed by excision (LAAC-EE) versus occlusion (LAAC-PO) for stroke prevention in patients with recurrent atrial fibrillation undergoing radiofrequency ablation.In this retrospective analysis, 160 consecutive patients (109 undergoing LAAC-EE and 51 undergoing LAAC-PO) were evaluated. To adjust for baseline differences, stabilized inverse probability of treatment weighting (IPTW) was applied using a logistic regression model with age, sex, and CHA₂DS₂-VASc score as predictors. Weighted Kaplan-Meier survival analyses were conducted to assess stroke-free survival over a 5-year follow-up period, and weighted Cox proportional hazards regression was used to evaluate the association between LAAC modality and stroke occurrence, adjusting for age, sex, diabetes, CHA₂DS₂-VASc score, HAS-BLED score, and left atrium size.Results: Overall, the weighted mean CHA2DS2-VASc score was 3.1 ± 0.1 (3.0 ± 0.2 in LAAC-EE vs. 3.3 ± 0.2 in LAAC-PO; p = 0.159), indicating moderate baseline stroke risk.When stratified, 39.2% of LAAC-EE and 18.9% of LAAC-PO patients were in the low-risk category (CHA2DS2-VASc ≤ 2), 48.2% vs. 69.6% in the medium-risk group (score 3-4), and 12.6% vs. 11.5% in the high-risk group (score ≥ 5) (p = 0.093). Over 5 years, stroke occurred in 64 patients-29.4% in the LAAC-EE group versus 62.7% in LAAC-PO-and weighted Kaplan-Meier analysis showed significantly greater stroke-free survival with excision (log-rank p < 0.001). In the weighted multivariate Cox model, LAAC-EE was associated with a non-significant 51.6% reduction in stroke risk (HR 0.48; 95% CI 0.13-1.74; p = 0.27). Age (HR 1.09 per year; p = 0.008) and HAS-BLED score (HR 10.54; p < 0.001) remained significant predictors, whereas sex, diabetes, and CHA₂DS₂-VASc score did not.Although the multivariate analysis did not achieve statistical significance for the treatment modality, the observed hazard ratio indicates that LAAC-EE may reduce stroke risk by approximately 51.6% compared to LAAC-PO. The significant impact of age and HAS-BLED score on stroke risk underscores the importance of individualized patient selection. These findings suggest a potential clinical benefit of LAAC-EE, particularly among lower-risk patients, and warrant further investigation in larger prospective studies.
Keywords: Radiofrequency ablation, Left atrial appendage, excision, occlusion, Stroke
Received: 27 Mar 2025; Accepted: 15 May 2025.
Copyright: © 2025 Abibe Goia, Hu and Meng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qiuming Hu, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.