Left atrial appendage occlusion in patients with atrial fibrillation
Topic Status Complete
Left atrial appendage occlusion in patients with atrial fibrillation
Outcome of the appraisal
The evidence does not support the routine adoption of left atrial appendage occlusion in adults with non-valvular atrial fibrillation who have contraindications to oral anticoagulation.
There are no comparative studies of left atrial appendage device occlusion compared with standard care in adults with non-valvular atrial fibrillation in whom oral anticoagulation is contraindicated, although non-comparative observational studies suggest that left atrial appendage occlusion reduces the rate of ischaemic stroke.
The cost-utility analysis concludes that while LAAO in addition to standard care may be more effective than standard care with aspirin alone, it is cost incurring and not cost effective with an ICER of £42,302 per QALY.
Why was this topic appraised?
Atrial fibrillation (AF) is the most common type of heart rhythm disturbance and is characterised by an irregular and often rapid heartbeat. Since atrial fibrillation can lead to the stasis of blood and blood clot formation in the heart, blood thinners (oral anticoagulants), such as warfarin and direct-acting oral anticoagulants, are recommended for people with AF to reduce the risk of stroke. However, a proportion of people with AF cannot take these drugs due to a variety of contraindications, including a history of previous bleeding.
Left atrial appendage occlusion (LAAO) is a percutaneous treatment that involves the introduction, through the circulation, of a device that mechanically blocks the left atrium appendage, a sac at the back of the heart from which most blood clots are thought to arise.
HTW considered this topic after it was proposed by the Welsh Health Specialised Services
Plain language summary
Atrial fibrillation (AF) an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart. These blood clots most often form in the part of the heart known as the left atrial appendage, which is in the left atrium. AF isn’t usually life-threatening, but if a blood clot forms then it could lead to a stroke. It is therefore important that AF is managed to prevent a stroke event.
Anticoagulants are medications that aim to prevent blood clots and are recommended to people with AF to prevent stroke. However, not everyone can take anticoagulants. Left atrial appendage occlusion (LAAO) is proposed to be an alternative method to prevent blood clots in people with AF who cannot take anticoagulants. LAAO is a type of heart surgery in which the LAAO device is inserted into the left atrium, blocking off the part of the heart where blood clots are most likely to form.
Health Technology Wales looked for evidence on left atrial appendage occlusion to treat adults with atrial fibrillation that are contraindicated to anti-coagulants. The evidence does not support the routine adoption of left atrial appendage occlusion in adults with non-valvular atrial fibrillation who have contraindications to oral anticoagulation.
Topic Exploration Report
TER309 09.2021
Evidence Appraisal Review
EAR041 08.2022
Guidance
GUI041 08.2022
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