Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation.

The New England journal of medicine·April 2, 2026·PMID: 41849741

What's New

Left atrial appendage closure failed to demonstrate noninferiority to medical therapy for stroke and bleeding prevention in high-risk atrial fibrillation patients.

Detailed Summary

A multicenter randomized trial of 912 adults with atrial fibrillation at high risk for stroke and bleeding compared catheter-based left atrial appendage closure to physician-directed best medical care over a median of 3 years. The device group had a higher composite event rate (16.8 vs. 13.3 per 100 patient-years), and noninferiority was not established (P=0.44).

Study Population

Adults with atrial fibrillation at high risk for stroke and bleeding (mean age 77.9±7.1 years; 38.6% women; n=912)

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