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Atrial Fibrillation Guidelines

CE / CME

Charting a Course for Success: Navigating New Guidelines in Atrial Fibrillation Management and Treatment

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurses: 1.00 Nursing contact hour

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: June 26, 2024

Expiration: June 25, 2025

Christopher B. Granger
Christopher B. Granger, MD
CME/CE Information

Activity

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Left Atrial Appendage Occlusion to Prevent Stroke

Listen to this brief audio clip about updated recommendations on left atrial appendage occlusions.

The 2023 ACC/AHA Guidelines on Atrial Fibrillation  included updates of the recommendations around left atrial appendage occlusion.1 The LAAOS III trial helped inform these recommendations.29

This was a multicenter, randomized trial involving 4770 patients with atrial fibrillation and a CHA2DS2-VASc score ≥2 who were scheduled to undergo cardiac surgery for another indication. The patients were randomly assigned to undergo or not undergo occlusion of the left atrial appendage during surgery; all patients were expected to receive usual care, including oral anticoagulation, during follow-up. 

There was a one-third reduction in stroke risk in those who underwent occlusion. The incidence of perioperative bleeding, heart failure, or death did not differ significantly between the trial groups.

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2023 ACC/AHA Guidelines: Recommendations on Left Atrial Appendage Exclusion in Patients With Atrial Fibrillation

The results of LAAOS III trial led to a Class 1a recommendation that for patients with atrial fibrillation undergoing cardiac surgery with a CHA2DS2-VASc ≥2, surgical left atrial appendage exclusion in addition to continued anticoagulation is indicated to reduce the risk of stroke and systemic embolism.1

An additional recommendation for left atrial appendage occlusion received a Class 2a recommendation. This procedure should be considered for patients with atrial fibrillation with long-term contraindications to oral anticoagulation, for example, those with recurrent gastrointestinal bleeding. This lower level of recommendation also applies to those who refuse to receive DOACs.1

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An 81-year-old woman presents with paroxysmal atrial fibrillation. Her weight is 48 kg. She has a bioprosthetic aortic valve. Her serum creatinine is 1.0 mg/dL (creatinine clearance: 30 mL/min). She has a history of falls approximately once every 2 months. Her medications include apixaban 2.5 mg twice daily for anticoagulation and naproxen for arthritis in her knees. She drinks 2 glasses of wine and 2 cups of coffee each day.

What should be done given her frailty?

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