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Atrial fibrillation is a common heart disease involving an irregular heart rhythm, known as an arrhythmia. Nonvalvular atrial fibrillation, atrial fibrillation that does not involve the heart valves, is the most common form of atrial fibrillation and can lead to stroke. In Ontario, stroke is the third-leading cause of death and the leading cause of disability in adults. The rate of stroke in people with atrial fibrillation is three to five times higher than in those without atrial fibrillation, and about 15% to 20% of those who have experienced stroke have nonvalvular atrial fibrillation.

In people with nonvalvular atrial fibrillation who experience stroke, the blood clots causing stroke arise from the left atrial appendage, a small sac in the muscle of the heart’s left atrium, in 90% of cases.

Stroke can be prevented in people with nonvalvular atrial fibrillation with medications such as novel oral anticoagulants or devices such as a left atrial appendage closure device with delivery system.

We assessed the effectiveness and cost-effectiveness of a left atrial appendage closure device with delivery system versus novel oral anticoagulants and oral antiplatelet medications in patients with nonvalvular atrial fibrillation.

The left atrial appendage closure device with delivery system is a minimally invasive alternative to treatment with oral anticoagulants for patients with nonvalvular atrial fibrillation. The device closes the left atrial appendage, which reduces the risk of blood clot formation.