title: Efficacy and Safety of Percutaneous Left Atrial Appendage Occlusion for Stroke Prevention in Nonvalvular Atrial Fibrillation: A Meta-analysis of Contemporary Studies.
abstract: BACKGROUND
  Percutaneous left atrial appendage (LAA) occlusion has emerged as an important treatment for patients with nonvalvular atrial fibrillation (NVAF) who are at high stroke risk and have contraindications for anticoagulation. However, literature about the efficacy and safety of LAA occlusion is minimal to date. We performed a meta-analysis to assess the rates of stroke events and adverse events for patients treated with occlusion devices.
  
  
  METHODS
  We conducted a comprehensive search on PubMed, Web of Science, OVID, SCOPUS databases and the Cochrane Central Register of Controlled Trials databases from inception to December 31, 2014 for studies of percutaneous LAA occlusion for patients with NVAF. Studies were included in the meta-analysis if at least 10 patients were studied with six months or more of follow-up period and reported at least one outcome of interest.
  
  
  RESULTS
  A total of 2779 patients in 25 studies were included in the meta-analysis. Two were randomised control trials (RCTs), others were cohort studies. The adjusted incidence rate of stroke was 1.2/100 person-years (PY) (95% confidence interval [CI], 0.9-1.6/100 PY). The ischaemic and haemorrhagic stroke rates were 1.1/100 PY (95% CI, 0.8-1.4/100 PY) and 0.2/100 PY (95% CI, 0.1-0.3/100 PY), respectively. The combined efficacy outcomes (stroke or transient ischaemic attacks [TIAs], systemic embolism, or cardiovascular death) was 2.7/100 PY (95% CI, 1.9- 3.4/100 PY). Major bleeding and pericardial effusions were the most commonly observed adverse events at a rate of 2.6% (95% CI, 1.5%-3.6%) and 2.5% (95% CI, 1.8%-3.2%), respectively.
  
  
  CONCLUSIONS
  Percutaneous LAA occlusion is a reasonably efficacious and safe therapeutic option in patients with NVAF who are at high risk for stroke and contraindicated for long-term anticoagulation.
authors.affiliation: Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, P. R. China.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, P. R. China.
authors.forename: Xiongwei
authors.initials: X
authors.lastname: Xie
authors.affiliation: Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, P. R. China.
authors.forename: Bingjian
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, P. R. China.
authors.forename: Shuren
authors.initials: S
authors.lastname: Ma
authors.affiliation: Department of Cardiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, P. R. China. Electronic address: wangfang_201309@163.com.
authors.forename: Fang
authors.initials: F
authors.lastname: Wang
mesh_terms: D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery*; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
keywords: Left atrial appendage; Nonvalvular atrial fibrillation; Occlusion; Stroke