Efficacy and safety of left atrial appendage occlusion in atrial fibrillation patients with chronic kidney disease: a systematic review and meta-analysis

Abstract

Atrial fibrillation (AF) is the most common arrhythmia among the elderly, and more frequently occur in those with chronic kidney disease (CKD). Left atrial appendage occlusion (LAAO) is used as a mechanical alternative approach for prevention of AF-related thromboembolisms. This meta-analysis was conducted to provide suggestions for the clinical application of LAAO in AF patients with CKD. The incidence of perioperative adverse events and other clinical effects after operation was by a single rate meta-analysis. Results showed that incidence of adverse events in the perioperative period after LAAO was generally low, with only pericardial effusion / tamponade (1.90%) and mortality rate (1.10%). During the follow-up period, the incidence of stroke/transient ischemic attack (TIA) and bleeding were 2.17% and 4.53%, respectively. A low incidence rate of adverse events was found in the perioperative period following LAAO. These results indicate that LAAO more effectively prevents the occurrence of stroke/TIA and minimizes bleeding events than oral anticoagulants.

Role of Anticoagulants for Stroke Prevention in Low-Risk Population Having Atrial Fibrillation and Chronic Kidney Disease: A Systematic Review

“…Following that, articles are fairly narrowed and screened by their titles or abstracts using the inclusion/exclusion criteria. Finally, articles underwent quality assessments, and the eligible reports came down to a total of eight articles [3,5,7,[8][9][10]12,13]. Figure 2 shows an in-depth overview of the process adopted, namely identification, screening, and the inclusion of articles.…”

“…Thus, it could be a safer option for younger groups. More studies need to be done on this matter to opine further [ 13 ]. Table 3 provides a summary of all the articles discussed in this section.…”

Left atrial appendage occlusion in patients suffering from advanced chronic kidney disease (stage 4 and 5). Long‐term follow‐up

“…42 A meta-analysis conducted by Zhang, found almost the same ratio (HR: 2.0) as our results. 43 It is remarkable that HASBLED was identified as an independent predictor of death in the A-CKD cohort. These findings should be taken into account when LAAO is considered in these patients.…”

Practical approaches to building up a cardiorenal clinic

“…The available data suggest that direct oral anticoagulants have a better safety and efficacy profile in patients with CKD, but data in patients with advanced CKD are scarce [ 50 ]. On the other hand, left atrial appendage occlusion has been shown to reduce the incidence of thromboembolic events in patients with AF, with a low incidence of adverse events, so this strategy should be considered for patients with an increased risk of bleeding [ 51 ].…”