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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

Pharmacists: 1.00 contact hour (0.1 CEUs)

Nurse Practitioners/Nurses: 1.00 Nursing contact hour

Physicians: maximum of 1.00 AMA PRA Category 1 Credit

Released: June 26, 2024

Expiration: June 25, 2025

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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.

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

What should be done given her frailty?