Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation

In this article, the authors report the results of the randomized CLOSURE AF trial, which compared left atrial appendage closure with physician-directed best medical therapy in 888 high-risk patients with atrial fibrillation. The mean age was 77.9 years, the mean CHA2DS2-VASc score was 5.2, and the mean HAS-BLED score was 3.0. After a median follow-up of 3.0 years, the primary composite endpoint occurred in 155 of 446 device patients vs 127 of 442 medical therapy patients, or 16.8 vs 13.3 events per 100 patient-years. Noninferiority was not met (difference in restricted mean survival time, -0.36 years; 95 percent confidence interval (CI), -0.70 to -0.01; P=0.44). Stroke rates were identical at 27 per group. The authors conclude that left atrial appendage closure did not provide an advantage over contemporary medical therapy in this population.