3-Year outcomes after left atrial appendage closure in patients with nonvalvular atrial fibrillation: cardiomyopathy related with increased death and stroke rate

Abstract

Introduction Left atrial appendage closure (LAAC) is a novel treatment for stroke prevention in high-risk patients with non-valvular atrial fibrillation (NVAF). However, the long-term outcomes after LAAC in Chinese NVAF patients are still lacking. Methods This was a single-center, bidirectional, nonrandomized registered study. Patients who underwent LAAC implantation from May 2014 to April 2021 in a large Chinese center were enrolled. The primary endpoint was combined all-cause death and stroke. Results From May 2014 to April 2021, a total of 673 NVAF patients were enrolled. The overall successful implantation rate was 97.62% (657 of 673). The rate of perioperative adverse events was 1.19% (8 of 673), including 3 cardiac tamponades, 2 ischemic strokes, one device-related thrombus (DRT) and 2 device dislocations. 604 (92.24%) patients completed the follow-up, the median follow-up period was 36.9 months (IQR 24.8–56.5 months). 16 stroke events occurred in 15 patients (one patient suffered from both hemorrhagic and ischemic strokes). 13 patients (2.15%) had ischemic stroke, and the fatal rate was 0.33% (2 of 604). 3 patients (0.15%) suffered from hemorrhagic stroke, and the fatal rate was 0.17% (1 of 604). The overall stroke rate was 0.74% per-year. The combined death and stroke rate was 1.93% per-year. In the multivariate Cox regression analysis, age ≥ 75 (hazard ratio 2.264, 95% CI 1.074–4.772, P = 0.032) and ventricular cardiomyopathy (hazard ratio 2.738, 95% CI 1.060–7.071, P = 0.037) were independent predictors of combined mortality and stroke. Conclusion The overall successful implantation rate of LAAC was 97.62% and the rate of perioperative adverse events was 1.19% in this study, and the stroke rate was 0.74% per year during the long-term follow-up. Age ≥ 75 years and ventricular cardiomyopathy were independent predictors of the primary endpoint. Trial registration This study was retrospectively registered.

Comparative Assessment of Percutaneous Left-Atrial Appendage Occlusion (LAAO) Devices—A Single Center Cohort Study

“…This study’s comprehensive evaluation of percutaneous left atrial appendage (LAA) closure using various occluder devices at our center from 2009 to 2023 underscores the procedure’s efficacy and safety in patients with nonvalvular AF who are contraindicated for or intolerant to oral anticoagulation therapy. Continuous improvements in the LAAC procedure and device technology have significantly contributed to the procedural safety and efficacy, as evidenced by the consistent high success rates in major trials such as PROTECT (90.9%), CAP (94.4%), PREVAIL (95.1%), CAP2 (94.8%), and EWOLUTION (98.5%) [ 9 ]. The overall procedural success rate of 95.7% in our study showed no significant difference between devices, demonstrating the technical feasibility of LAA closure across different device generations.…”