The CLOSURE-AF trial is the first randomized study suggesting worse outcomes of LAA closure compared to medical therapy in high-risk atrial fibrillation patients.
Key points:
- No difference in stroke prevention, bleeding rate even slightly higher after LAA closure
- Outcomes driven by early procedural risk
- Extremely high-risk patient population
At first glance, CLOSURE-AF appears to challenge the role of LAA closure. However, a closer look at the data suggests that the key issue is not the efficacy of the procedure itself, but patient selection and procedural risk. Stroke rates were comparable between groups, indicating preserved effectiveness of LAA closure for embolic prevention. The difference in outcomes was mainly driven by early procedural complications in a very high-risk and elderly population.
These findings are unlikely to fundamentally change current guideline recommendations, but they may lead to a more refined and selective use of LAA closure in clinical practice.
Watchman FLX
Watchman 2.5
Amulet
LAmbre
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