Impact of chronic kidney disease on Watchman implantation: experience with 300 consecutive left atrial appendage closures at a single center

Abstract

The prevalence of chronic kidney disease (CKD) is high in patients with atrial fibrillation (AF). Left atrial appendage closure (LAAC) has been recognized as an efficient alternative to oral anticoagulation for the prevention of thromboembolic events in patients with non-valvular AF (NVAF); however, the long-term safety and efficacy of LAAC in patients with CKD remain unclear. This study was designed to provide data regarding the safety and efficacy of LAAC in NVAF patients with CKD. A real-world analysis of the safety and efficacy of LAAC was performed on a cohort of 300 NVAF patients with or without CKD who underwent LAAC using the Watchman (WM) device at our center. The patients with CKD (n = 151) were significantly older (77.0 ± 7.2 vs. 73.2 ± 7.8 years, respectively, P < 0.0001) and had a higher CHA2DS2-VASc score (4.3 ± 1.5 vs. 3.4 ± 1.4, respectively, P < 0.0001) and HAS-BLED score (4.0 ± 1.0 vs. 3.0 ± 1.0, respectively, P < 0.0001) than the patients without CKD (n = 149). However, there were no differences between groups with respect to the device implant success rate (98.7 vs. 97.3%, respectively, P = 0.446) or severe periprocedural complications within 7 days. The patients were followed up for 637 ± 398 days, and all patients received repeat transesophageal echocardiography (TEE). Thirteen (4.3%) device-related thrombi, 3 (1.0%) ischemic strokes, and 19 (6.3%) non-procedural major bleeding cases were documented, and there were no differences in these complications between groups. The observed rate of all thromboembolic events by Kaplan–Meier analysis decreased by 68.8% (CKD) and 48.6% (non-CKD); moreover, the observed annual rate of bleeding was reduced by 57.5% (CKD) and 11.4% (non-CKD). Our results indicate that LAAC with the WM device is safe and effective in preventing stroke in NVAF patients with and without CKD.

Percutaneous left atrial appendage closure for stroke prevention in patients with chronic renal disease

“…Stroke reduction was similarly high in patients with CKD and patients with normal renal function with no impact of the CKD stages on the periprocedural major adverse events. This is confirmed by Xue et al [30], whose study using the Watchman Device documented no differences in complications in the CKD vs. the non-CKD group. Moreover, the observed bleeding rate reduction was significantly higher in the CKD group compared to the non-CKD group.…”

Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis

“…In the last years, Left Atrial Appendage (LAA) occlusion has emerged as an alternative option to OAT for AF patients who are at high thromboembolic risk [9] and not suitable for OAT and recent cardiology guidelines state that LAA occlusion should be considered in this subset of patients [10]. Retrospective studies suggest the efficacy of LAA occlusion in reducing thromboembolic risk in patients with chronic kidney disease (CKD), but very few data are available on outcomes in ESRD patients [11][12][13][14]. Recently, we reported the design of the study and some preliminary results about feasibility of LAA occlusion in dialysis patients [15].…”

Calciphylaxis in the Setting of Hemodialysis, Liver Cirrhosis, and Warfarin Therapy for Atrial Fibrillation: An Argument for Alternative Anti-Embolic Therapy

“…Warfarin therapy is challenging in patients with renal disease as it can increase the risk of vascular calcification and cause acute kidney injury secondary to anticoagulant-related nephropathy (ARN) or warfarin-related nephropathy (WRN) [18]. In high-risk patients with non-valvular AF who are in need of an alternative to long-term OAT, an FDA-approved left atrial appendage (LAA) closure device, also called a WATCHMAN device, is a possible option for stroke risk reduction and should be considered ( Figure 5) [17,[19][20].…”