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ARVC Cascade Screening Protocol — EECC MCQ

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HardGeneral CardiologyARVC Cascade Screening ProtocolEECC

A 76-year-old with non-valvular atrial fibrillation and previous embolic stroke has recurrent transfusion-requiring angiodysplasia bleeding despite endoscopic treatment. Two appropriately selected DOAC regimens have been stopped after further major bleeding, and the endocardial anatomy is suitable. Which stroke-prevention strategy should now be discussed?

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Correct answer: A — Percutaneous left-atrial-appendage occlusion after joint cardiology and gastroenterology assessment

LAA occlusion can be considered when embolic risk is substantial and long-term anticoagulation is contraindicated or not tolerated after attempts to address bleeding. Dual antiplatelet therapy is less effective than anticoagulation, while an unlicensed DOAC dose may preserve bleeding risk without proven protection. AV-node ablation controls ventricular rate but does not remove appendage thrombus risk, and bleeding history does not abolish cardioembolic risk.

Reference: NICE NG196: Atrial fibrillation — recommendations. https://www.nice.org.uk/guidance/ng196/chapter/Recommendations