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Interventional occlusion of left atrial appendage in patients with atrial fibrillation. Acute and long-term outcome of occluder implantation in the LAARGE Registry

  • Johannes Brachmann
  • Thorsten LewalterEmail author
  • Ibrahim Akin
  • Horst Sievert
  • Volker Geist
  • Uwe Zeymer
  • Damir Erkapic
  • Harald Mudra
  • Sven Pleger
  • Matthias Hochadel
  • Jochen Senges
MULTIMEDIA REPORT

Abstract

Background

Left atrial appendage occluder (LAAO) implantation is an alternative method for stroke prevention in atrial fibrillation (AF) patients who are not eligible for long-term oral anticoagulation. The present paper describes the acute and 1-year follow-up outcome data of the prospective, multicenter German left atrial appendage occlusion registry (LAARGE).

Methods

LAARGE enrolled 641 patients who were scheduled for LAAO implantation. The data collected included demographics, clinical characteristics, procedure indication, details of implantation, and outcome; patients were followed at 1-year post-implant. Efficacy and safety during follow-up are assessed by the occurrence of thrombembolic and bleeding events, respectively.

Results

A total of 641 consecutive patients (mean age: 75.9 ± 8.0) were enrolled from July 2014 to January 2016 in 38 hospitals in Germany. Patient demographics represent a critically-ill population with a calculated mean CHA2DS2-VASc score and HASBLED score of 4.5 and 3.9, respectively, with bleeding events as the main indication for LAAO implantation (79.4%). One-year all-cause mortality post-procedure was 11.5% with a non-fatal stroke/TIA rate of 1.3% (8 patients) and a rate of major bleeding of 1.6% (10 patients). The anticoagulation regimen after 1 year consisted of oral anticoagulation in 5.5% of patients and an antiplatelet therapy (APT) rate of 84.1% (majority single APT with ASS (74.5%), dual APT in 6.7%).

Conclusions

LAARGE, a prospective multicenter real-world and all-comer registry, is unique in its concept, as it is non-manufacturer sponsored and includes all commercially available devices. LAAO implantation is mainly performed in elderly, critically-ill patients with a history of bleeding. LAARGE demonstrates a favorable outcome at 1-year follow-up in terms of stroke/TIA (1.3%) and major bleeding (1.6%) while using a single APT in the vast majority of patients.

Keywords

Atrial fibrillation Left atrial appendage occluder Stroke 

Abbreviations

LAAO

left atrial appendage occluder

AF

atrial fibrillation

OAC

oral anticoagulation

LAARGE

Left Atrial Appendage Occlusion Registry Germany

CAD

coronary artery disease

CKD

chronic kidney disease

Notes

Compliance with ethical standards

Conflict of interest

T.L., J.B., and H.S. have received moderate speaker honoraria from Boston Scientific and Abbott, no conflict of interest for the remaining authors

Ethical approval

The LAARGE registry received ethical approval in April 2014 from the State Chamber of Medicine of Rhineland-Palatinate. All aspects of the registry comply with the principles of Good Clinical Practice (GCP) and the Declaration of Helsinki.

Informed consent

All enrolled patients provided written informed consent to be included in the registry and to participate in the follow-up.

Supplementary material

10840_2019_635_MOESM1_ESM.doc (930 kb)
ESM 1 (DOC 929 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Johannes Brachmann
    • 1
  • Thorsten Lewalter
    • 2
    Email author
  • Ibrahim Akin
    • 3
  • Horst Sievert
    • 4
  • Volker Geist
    • 5
  • Uwe Zeymer
    • 6
    • 7
  • Damir Erkapic
    • 8
  • Harald Mudra
    • 9
  • Sven Pleger
    • 10
  • Matthias Hochadel
    • 7
  • Jochen Senges
    • 7
  1. 1.Department of CardiologyKlinikum CoburgCoburgGermany
  2. 2.Department of Cardiology and Intensive Care, Peter Osypka Heart Center MunichHospital for Internal Medicine Munich SouthMunichGermany
  3. 3.Department of CardiologyUniversity Hospital MannheimMannheimGermany
  4. 4.Department of CardiologyKatharinenhospital FrankfurtFrankfurtGermany
  5. 5.Department of CardiologyKlinkum Bad SegebergBad SegebergGermany
  6. 6.Department of CardiologyKlinikum LudwigshafenLudwigshafenGermany
  7. 7.Institut für HerzinfarktforschungLudwigshafenGermany
  8. 8.Department of CardiologyUniversity Hospital GiessenGiessenGermany
  9. 9.Department of CardiologyKlinikum NeuperlachMunichGermany
  10. 10.Department of CardiologyUniversity Hospital HeidelbergHeidelbergGermany

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