Safety of LAA Closure by Minimally Invasive Procedure vs. OACS in Patients with Atrial Fibrillation - An Umbrella Meta-Analysis

Document Type

Abstract

Publication Date

4-1-2025

Abstract

Background: This umbrella meta-analysis assesses the safety of left atrial appendage (LAA) closure by minimal invasive procedures compared to oral anticoagulants (OACs) in patients with atrial fibrillation (AF), concentrating on adverse events and overall clinical outcomes. The results seek to elucidate the most effective treatment. This umbrella meta-analysis intends to evaluate the safety and efficacy of minimally invasive LAA closure in comparison to OAC in AF. Methods: We adhered to the PRISMA protocol to perform an umbrella meta-analysis of published meta-analyses comparing the outcomes of LAA occlusion using the Watchman or Amulet devices vs OACs in patients with atrial fibrillation (AF). Relevant studies were identified through PubMed using MeSH terms. Non-human studies, non-English publications, studies that were not meta-analyses, and those lacking outcome data were excluded based on predefined inclusion and exclusion criteria. Data analysis was conducted using RevMan 5.4, employing the inverse variance method and a randomeffects model to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Forest plots and heterogeneity (I2) were also generated, with statistical significance defined at an alpha level of 0.05. Risk of bias assessed by Newcastle-Ottawa Scale (NOS). Results: Of 19 studies, 12 had data on outcomes. Watchman or Amulet devices had reduced odds of mortality [aOR: 0.65, 95%CI: 0.59-0.71, I2: 0%, p < 0.00001] [all cause mortality (0.70, 0.62-0.79, 0%, p < 0.00001), CV mortality (0.58, 0.50-0.67, 0%, p < 0.00001)], risk of stroke [0.77, 0.60-0.98, 75%, p = 0.06], and major bleeding [0.76, 0.59-0.96, 61%, p = 0.02] in comparison with OACs. NOS suggested a moderate risk of bias. Conclusions: Watchman and Amulet devices provide safer left atrial appendage (LAA) closure than oral anticoagulants (OACs) in atrial fibrillation patients. All-cause, cardiovascular, stroke, and severe bleeding death rates are much lower. More prospective studies and clinical trials will help with risk stratification and cohort selection who may get the most benefit out of these procedures.

Publication Title

Journal of Hospital Medicine

Volume

20

Issue

Supplement 1

First Page

S216

Last Page

S217

Link to Full Text

Open Access

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