Long-term outcomes following percutaneous left atrial appendage closure in patients with atrial fibrillation and contraindications to anticoagulation
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We aimed to evaluate the late clinical outcomes of percutaneous LAA closure in patients with atrial fibrillation (AF) and contraindication to oral anticoagulation.
Consecutive AF patients with contraindications to oral anticoagulation who underwent successful LAA closure between December 2008 and March 2013 at four centers were included.
A total of 101 patients (median age 76 [IQR 69–80] years, 48% women, mean CHA2DS2-VASc 5 ± 2; HAS-BLED 4 ± 1) were included. Eighty-six (85.1%) patients received an Amplatzer Cardiac Plug/Amulet device and 15 (14.9%) patients a Watchman device. The mean follow-up period was 4 ± 1 years. During 358.6 patient-years of follow-up, 7 (6.9%) patients suffered a major stroke (2 cases per 100 person-years; expected rate: 6.2 cases per 100 person-years), and 20 (19.8%) patients experienced at least one episode of major bleeding (6.4 cases per 100 person-years; expected rate: 9.0 cases per 100 person-years). There were no cases of late adverse events related to the device. A total of 34 (33.7%) patients died during follow-up (9.5 cases per 100 person-years). Older age, male sex, low ejection fraction, and chronic kidney disease were identified as predictive factors of late mortality.
Percutaneous LAA closure is safe and effective in the long term in patients with AF with contraindications to anticoagulation. However, a high long-term mortality rate was observed in this high-risk population. Comprehensive patient assessment prior to undergoing LAA closure should identify patients in whose comorbidities limit their overall prognosis.
KeywordsLeft atrial appendage closure Bleeding Stroke
Ander Regueiro and Tania Rodriguez-Gabella were supported by a grant from the Fundacion Alfonso Martin Escudero, Madrid, Spain. Josep Rodés-Cabau holds the Canadian Research Chair “Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions.
Compliance with ethical standards
Conflict of interest
Dr. Ignacio Cruz-Gonzalez is proctor and consultant for St. Jude Medical and Boston Scientific. All other authors declare that they have no conflicts of interest.
All procedures were performed in accordance with the local ethics committee of each center.
All patients gave written informed consent before the procedure(s).
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