Indications and Outcome in Patients Undergoing Left Atrial Appendage Closure—The Austrian LAAC Registry

Abstract

Background: Complete real-world data on the indications and outcomes of left atrial appendage closure (LAAC) outside of clinical trials are rare. In this study, we stratified patients undergoing LAAC by indication groups. Methods: This analysis of the national multicentre Austrian LAAC Registry comprised all patients that underwent LAAC up until 2018 at the currently active centres in Austria. The baseline characteristics, procedural details and outcomes between the following indication groups were compared: bleeding as an indication for LAAC (“bleeding” group) vs. thromboembolism despite oral anticoagulation (OAC; “thromboembolism” group) vs. an intolerance to OAC for reasons other than the above (“other” group). Results: The analysis included 186 patients, with 59.7% in the “bleeding” group, 8.1% in the “thromboembolism” group and 32.2% in the “other” group. The CHADS2 score was the highest in the “thromboembolism” group and the HAS-BLED score was the highest in the “bleeding” group. The procedural outcomes were similar between groups (implantation success, 97.3%), with major complications occurring in 7.0% of patients. One-year survival free from stroke, bleeding or LAAC-associated hospitalisation was 83.9%, 90.0% and 81.4% in the “bleeding”, “thromboembolism” and “other” groups, respectively (p = 0.891). Conclusions: In routine clinical practice, LAAC was used in a heterogeneous patient population with atrial fibrillation (AF) and contraindication, inefficacy or intolerance to OAC. The long-term outcome was favourable in all groups.

Not to Rush—Laboratory Parameters and Procedural Complications in Patients Undergoing Left Atrial Appendage Closure

“…Currently, patients undergoing LAAC in Austria represent a high-risk cohort with a mean CHA 2 DS 2 -VASc score of 4.4, a median HAS-BLED score of 3.1, and a history of stroke in almost half of patients (47%). Due to limitations in reimbursement, a dramatic ischaemic or haemorrhagic event usually precedes the decision to perform LAAC in most patients [ 11 ]. Baseline ischaemic and haemorrhagic risk is similar to the Left Atrial Appendage Closure Registry [ 4 ].…”

“…Details about the recruitment, indications, and outcomes in LAAC patients in Austria have been published elsewhere [ 11 ]. In short, patients with AF, a high thromboembolic risk, and either contraindications, intolerances, or ineffectiveness of OAC were evaluated at each of the referral centres in Austria.…”

Risks associated with discontinuation of oral anticoagulation in newly diagnosed patients with atrial fibrillation: Results from the GARFIELD‐AF Registry

“…The latter are commonly associated as they are performed most frequently in patients with contraindications to OACs. 36 , 37 , 38 , 39 Certainly, left atrial appendage closure procedures have been demonstrated as noninferior to OAC treatment for the prevention of stroke/SE, making it an attractive alternative for patients with OAC contraindications. 40 However, the absolute number of these procedures was low.…”

“…In addition to bleeding episodes, new thrombotic events (stroke, MI) as well as left atrial appendage closure procedures were often associated with OAC discontinuation. The latter are commonly associated as they are performed most frequently in patients with contraindications to OACs 36–39 . Certainly, left atrial appendage closure procedures have been demonstrated as noninferior to OAC treatment for the prevention of stroke/SE, making it an attractive alternative for patients with OAC contraindications 40 .…”

Outcomes of cardiac surgery with left atrial appendage occlusion versus no Occlusion, direct oral Anticoagulants, and vitamin K Antagonists: A systematic review with Meta-analysis

“…Moreover, it is unclear in the medical literature, whether or not antithrombotic pharmacotherapy is necessary after LAAO [6] . Potential indications for surgical LAAO include hospitalization, thromboembolism, transient ischemic attack, ischemic stroke, and bleeding [7] .…”