LAA Occlusion Indication — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateArrhythmia & ElectrophysiologyLAA Occlusion IndicationEECC

A 60-year-old man with AF has a CHA₂DS₂-VA score of 5 and a HAS-BLED score of 4. He has had recurrent major GI bleeding on DOACs. What non-pharmacological stroke prevention strategy may be considered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Percutaneous left atrial appendage occlusion (LAAO) — may be considered as an alternative to OAC in patients with absolute contraindications to long-term anticoagulation

Left atrial appendage occlusion (LAAO) with devices such as Watchman or Amulet is a percutaneous catheter-based procedure that seals the LAA (source of >90% of thrombi in non-valvular AF). The PROTECT-AF and PREVAIL trials demonstrated non-inferiority of LAAO to warfarin for stroke prevention in AF. The 2024 ESC AF Guidelines include LAAO as a Class IIb recommendation for patients with contraindications to long-term anticoagulation (particularly those with recurrent life-threatening bleeding on OAC despite source treatment). After LAAO, short-term anticoagulation or DAPT is typically required for 3-6 months (to allow device endothelialisation), followed by single antiplatelet or no antithrombotic therapy. LAAO is not routinely recommended as an alternative to OAC in patients who can tolerate anticoagulation.

Reference: ESC (2024): AF Guidelines; PROTECT-AF/PREVAIL Trials