Skip to main content
SpringerLink
Log in

Efficacy and safety of left atrial appendage closure in non-valvular atrial fibrillation in patients over 75 years

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Percutaneous left atrial appendage closure (LAAC) may decrease risks of stroke and bleeding in elderly patients with non-valvular atrial fibrillation (NVAF), but it is still lacking of evidence. The present study aimed at evaluating the efficacy and safety of LAAC in patients with NVAF over 75 years. 351 patients with NVAF who underwent LAAC were retrospectively analyzed on the LAAC procedure characteristics and the clinical follow-up according to age (age ≥ 75 years or < 75 years). Out of the 351 patients, LAA were successfully closed in 347 patients (98.9%), including 341 with Watchman (WM) device and 6 with Amplatzer cardiac plug (ACP) device because of the WM device-incompatible anatomy. There were no significant differences in total LAAC success rate and procedure-related major complications within 7 days between the groups aged ≥ 75 years and aged < 75 years. After a nearly 2-year follow-up, there was an increased trend of major bleedings and all bleedings in the group aged ≥ 75 years, but there were no significant differences between both groups in all-cause death, cardiovascular death, stroke/TIA/system embolism, device thrombus and device gap (> 5 mm). Kaplan–Meier analysis revealed that the relative risk of annual thromboembolic events between the observed values and the expected ones based on CHA2DS2-VASc score in the group aged ≥ 75 years decreased more obviously (61.9% vs. 54.3%); however, the relative risk of bleedings between the observed values and the expected ones based on HAS-BLED score in the younger group aged < 75 years decreased more significantly (59.6% vs. 29.2%). LAAC in patients with advanced age (age ≥ 75 years), has the same level of efficacy, safety and feasibility as in the younger patients aged < 75 years. Thus, LAAC may be an ideal choice to prevent stroke in NVAF patients with advanced age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pisters R, Lane DA, Marin F, Camm AJ, Lip GY (2012) Stroke and thromboembolism in atrial fibrillation. Circ J 76(10):2289–2304

    Article  Google Scholar 

  2. Wolf PA, Abbott RD, Kannel WB (1991) Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 22(8):983–988

    Article  CAS  Google Scholar 

  3. Albertsen IE, Rasmussen LH, Overvad TF, Graungaard T, Larsen TB, Lip GY (2013) Risk of stroke or systemic embolism in atrial fibrillation patients treated with warfarin: a systematic review and meta-analysis. Stroke 44(5):1329–1336

    Article  CAS  Google Scholar 

  4. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P, ESC Committee for Practice Guidelines (CPG) (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33(21):2719–2747

    Article  Google Scholar 

  5. Wysowski DK, Nourjah P, Swartz L (2007) Bleeding complications with warfarin use: a prevalent adverse effect resulting in regulatory action. Arch Intern Med 167(13):1414–1419

    Article  Google Scholar 

  6. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 18(11):1609–1678

    Article  Google Scholar 

  7. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yamashita T, Antman EM (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383(9921):955–962

    Article  CAS  Google Scholar 

  8. Mani H, Lindhoff-Last E (2014) New oral anticoagulants in patients with nonvalvular atrial fibrillation: a review of pharmacokinetics, safety, efficacy, quality of life, and cost effectiveness. Drug Des Dev Ther 8:789–798

    Article  CAS  Google Scholar 

  9. Holmes DR Jr, Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK, Huber K, Reddy VY (2014) Prospective randomized evaluation of the Watchman left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol 64(1):1–12

    Article  Google Scholar 

  10. Boersma LV, Schmidt B, Betts TR, Sievert H, Tamburino C, Teiger E, Pokushalov E, Kische S, Schmitz T, Stein KM, Bergmann MW, EWOLUTION investigators (2016) Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry. Eur Heart J 37(31):2465–2474

    Article  Google Scholar 

  11. Reddy VY, Sievert H, Halperin J, Doshi SK, Buchbinder M, Neuzil P, Huber K, Whisenant B, Kar S, Swarup V, Gordon N, Holmes D, PROTECT AF Steering Committee Investigators (2014) Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. JAMA 312(19):1988–1998

    Article  Google Scholar 

  12. Reddy VY, Doshi SK, Kar S, Gibson DN, Price MJ, Huber K, Horton RP, Buchbinder M, Neuzil P, Gordon NT, Holmes Jr DR, PREVAIL and PROTECT AF Investigators (2017) 5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF trials. J Am Coll Cardiol 70(24):2964–2975

    Article  Google Scholar 

  13. Asmarats L, Rodés-Cabau J (2017) Percutaneous left atrial appendage closure: current devices and clinical outcomes. Circ Cardiovasc Interv 10:e005359

    Article  Google Scholar 

  14. Masoudi FA, Calkins H, Kavinsky CJ, Drozda JP, Gainsley P, David J (2015) 2015 ACC/HRS/SCAI left atrial appendage occlusion device societal overview. Heart Rhythm 12(10):e122–e136

    Article  Google Scholar 

  15. Boston Scientific. Boston Scientific receives FDA approval for WATCHMAN left atrial appendage closure device—Mar 13, 2015

  16. Jiang L, Duenninger E, Muenzel M, Xue X, Fazakas A, Kei T, Yu J (2018) Percutaneous left atrial appendage closure with complex anatomy by using the staged 'Kissing-Watchman' technology with double devices. Int J Cardiol 265:58–61

    Article  Google Scholar 

  17. Lip GYH, Dagres N, Proclemer A, Svendsen JH, Pison L, Blomstrom-Lundqvist C (2013) Left atrial appendage occlusion for stroke prevention in atrial fibrillation in Europe: results of the European heart rhythm association survey. Europace 15(1):141–143

    Article  Google Scholar 

  18. Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, Murray E, BAFTA investigators, Midland Research Practices Network (MidReC) (2007) Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 370:493–503

    Article  CAS  Google Scholar 

  19. Davtyan KV, Kalemberg AA, Topchyan AH, Simonyan GY, Bazaeva EV, Shatahtsyan VS (2017) Left atrial appendage occluder implantation for stroke prevention in elderly patients with atrial fibrillation: acute and long-term results. J Geriatr Cardiol 14(9):590–592

    PubMed  PubMed Central  Google Scholar 

  20. Perera V, Bajorek BV, Matthews S, Hilmer SN (2009) The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation. Age Ageing 38(2):156–162

    Article  Google Scholar 

  21. Andreotti F, Rocca B, Husted S, Ajjan RA, ten Berg J, Cattaneo M, Collet JP, De Caterina R, Fox KA, Halvorsen S, Huber K, Hylek EM, Lip GY, Montalescot G, Morais J, Patrono C, Verheugt FW, Wallentin L, Weiss TW, Storey RF, ESC Thrombosis Working Group (2015) Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J 36(46):3238–3249

    CAS  PubMed  Google Scholar 

  22. Rosenman MB, Simon TA, Teal E, McGuire P, Nisi D, Jackson JD (2012) Perceived or actual barriers to warfarin use in atrial fibrillation based on electronic medical records. Am J Ther 19(5):330–337

    Article  Google Scholar 

  23. Bo M, Grisoglio E, Brunetti E, Falcone Y, Marchionni N (2017) Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence. Eur J Intern Med 3(7038):59–61

    Google Scholar 

  24. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro heart survey on atrial fibrillation. Chest 137(2):263–272

    Article  Google Scholar 

  25. Lip GY, Frison L, Halperin JL, Lane DA (2011) Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, Elderly, drugs/alcohol concomitantly) score. J Am Coll Cardiol 57(2):173–180

    Article  CAS  Google Scholar 

  26. Boersma LV, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Protopopov AV, Betts T, Foley D, Sievert H, Mazzone P, De Potter T, Vireca E, Stein K, Bergmann MW, EWOLUTION Investigators (2017) Efficacy and safety of left atrial appendage closure with WATCHMAN in patients with or without contraindication to oral anticoagulation: 1-year follow-up outcome data of the EWOLUTION trial. Heart Rhythm 14(9):1302–1308

    Article  Google Scholar 

Download references

Acknowledgements

We are indebted to the valuable comments on statistical analysis by Professor Hong Zhang from University of Science and Technology of China during manuscript preparation.

Author information

Author notes

  1. Jiangtao Yu and Hongwu Chen contributed equally to this work

Authors and Affiliations

  1. Department of Cardiology, Helmut-G.-Walther-Klinikum, Lichtenfels, Germany

    Jiangtao Yu, Hongwu Chen, Manuela Muenzel, Cody R. Hou, Mingzhong Zhao, Zhaohui Meng & Lisheng Jiang

  2. Clinic for General Internal Medicine and Cardiology, Katholisches Klinikum Koblenz Montabaur, Koblenz, Germany

    Jiangtao Yu

  3. Department of Cardiology, Katholisches Klinikum Koblenz Montabaur, Koblenz, Germany

    Felix Post

  4. Department of Cardiology, The 1st Affiliated Hospital of University of Science and Technology of China, Hefei, China

    Hongwu Chen

  5. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China

    Lisheng Jiang

  6. Department of Anesthesiology, Helmut-G.-Walther-Klinikum, Lichtenfels, Germany

    Thorsten Keil

  7. College of Biological Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA

    Cody R. Hou

  8. Department of Cardiology, The 9th Hospital Zhenzhou, Zhenzhou, China

    Mingzhong Zhao

  9. Department of Cardiology, The 1st Hospital of Kunming Medical University, Kunming, China

    Zhaohui Meng

Authors
  1. Jiangtao Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hongwu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Felix Post
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manuela Muenzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thorsten Keil
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cody R. Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mingzhong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhaohui Meng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lisheng Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Jiangtao Yu or Lisheng Jiang.

Ethics declarations

Conflict of interest

Jiangtao Yu received proctor fees from Boston Scientific. The other co-authors have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, J., Chen, H., Post, F. et al. Efficacy and safety of left atrial appendage closure in non-valvular atrial fibrillation in patients over 75 years. Heart Vessels 34, 1858–1865 (2019). https://doi.org/10.1007/s00380-019-01428-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-019-01428-8

Keywords

Search

Navigation