The
current real-world anticoagulation practices following left atrial appendectomy
in the context of the Maze procedure are unknown. This is a cohort study of all
patients who underwent the Maze procedure with amputation of the left atrial
appendage from June 2005 to November 2012. Data was prospectively collected at
regular intervals with an interview and Holter monitoring. All patients
received anticoagulation for 3 months. Those then kept on anticoagulation and
those for whom anticoagulation was stopped were compared in terms of death,
bleeding and incidence of stroke. In total, there were 113 patients, of whom 66
were treated with anticoagulation (Group A) and 47 were not (Group B). There
were no significant baseline differences between the two groups, including the
presence of atrial fibrillation (A:19.7%, B:10.6%, p=0.30), CHADS2 score
(A:1.41±1.05, B:1.15±1.08, p=0.19), and left atrial size (A:48.3±7.1mm, B:47.6±7.8
mm, p=0.57). There were 275 patient-years of follow-up, with an average of 2.43
years per patient. Only two patients experienced strokes, both in Group A
(p=0.27). Of the 5 bleeding events, 4 occurred in the first 3 months while on
anticoagulation and the remaining event occurred in Group A at 3 years
post-operatively (p=0.10). No standardized approach to anticoagulation after
the Maze procedure is apparent in real-world practice in an urban Canadian
setting. Patients who undergo the Maze procedure with amputation of the left
atrial appendage are at a low risk of stroke, but the optimal anticoagulation
strategy requires further investigation.
Credits: Jennifer Chung; Magdi Sami; Carole Albert; Benoit De Varennes