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Long-term outcomes following percutaneous left atrial appendage closure in patients with atrial fibrillation and contraindications to anticoagulation

  • Ander Regueiro
  • Ignacio Cruz-Gonzalez
  • Armando Bethencourt
  • Luis Nombela-Franco
  • Jean Champagne
  • Luis Asmarats
  • Pilar Jiménez-Quevedo
  • Tania Rodriguez-Gabella
  • Juan Carlos Rama-Merchan
  • Rishi Puri
  • Gilles O’Hara
  • Josep Rodés-Cabau
Article

Abstract

Purpose

We aimed to evaluate the late clinical outcomes of percutaneous LAA closure in patients with atrial fibrillation (AF) and contraindication to oral anticoagulation.

Methods

Consecutive AF patients with contraindications to oral anticoagulation who underwent successful LAA closure between December 2008 and March 2013 at four centers were included.

Results

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.

Conclusions

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.

Keywords

Left atrial appendage closure Bleeding Stroke 

Notes

Funding

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.

Ethical approval

All procedures were performed in accordance with the local ethics committee of each center.

Informed consent

All patients gave written informed consent before the procedure(s).

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ander Regueiro
    • 1
  • Ignacio Cruz-Gonzalez
    • 2
  • Armando Bethencourt
    • 3
  • Luis Nombela-Franco
    • 4
  • Jean Champagne
    • 1
  • Luis Asmarats
    • 1
    • 3
  • Pilar Jiménez-Quevedo
    • 4
  • Tania Rodriguez-Gabella
    • 1
  • Juan Carlos Rama-Merchan
    • 2
  • Rishi Puri
    • 1
  • Gilles O’Hara
    • 1
  • Josep Rodés-Cabau
    • 1
  1. 1.Quebec Heart & Lung InstituteLaval UniversityQuebec CityCanada
  2. 2.Hospital Universitario de SalamancaSalamancaSpain
  3. 3.Hospital Universitario Son EspasesPalma de MallorcaSpain
  4. 4.Instituo Cardiovascular, Hospital Clínico Universitario San Carlos, Instituto de Investigacion SanitariaMadridSpain

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