Left atrial appendage closure in end‐stage renal disease and hemodialysis: Data from a German multicenter registry

Abstract

Background Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). OAC treatment has been proven feasible in mild‐to‐moderate chronic kidney disease (CKD). In contrast, the optimal antithrombotic management of AF patients with end‐stage renal disease (ESRD) is unknown and LAAC has not been proven in these patients in prospective randomized clinical trials. Objectives The objective of this study is to evaluate safety and efficacy of LAAC in patients with ESRD. Methods Patients undergoing LAAC were collected in a German multicenter real‐world observational registry. A composite endpoint consisting of the occurrence of ischemic stroke/transient ischemic attack, systemic embolism, and/or major clinical bleeding was assessed. Patients with ESRD were compared with propensity score‐matched patients without severe CKD. ESRD was defined as a glomerular filtration rate < 15 ml/min/1.73 m2 or chronic hemodialysis treatment. Results A total of 604 patients were analyzed, including 57 with ESRD and 57 propensity‐matched patients. Overall, 596 endocardial and 8 epicardial LAAC procedures were performed. Frequency of major complications was 7.0% (42/604 patients) in the overall cohort, 8.8% (5/57 patients) in patients with ESRD, and 10.5% (6/57 patients) in matched controls (p = 0.75). The estimated event‐free survival of the combined endpoint after 500 days was 90.7 ± 4.5% in patients with ESRD and 90.2 ± 5.5% in matched controls (p = 0.33). Conclusions LAAC had comparable procedural safety and clinical efficacy in patients with ESRD and patients without severe CKD.

Percutaneous Left Atrial Appendage Closure in Patients with Non-Valvular Atrial Fibrillation and End-Stage Renal Disease on Hemodialysis: A Case Series

“…Two recent studies have specifically evaluated this complex scenario. On the one hand, Fink et al [32] collected patients from a German multicenter registry who underwent LAAC in order to evaluate the safety and efficacy of this technique in patients with ESRD. The study compared 57 patients with ESRD (defined as a glomerular filtration rate of <15 mL/min or chronic hemodialysis treatment) to a matched group of 57 patients without severe CKD.…”

Efficacy and safety of patients with chronic kidney disease undergoing left atrial appendage closure for atrial fibrillation

“…The studies we included spanned from 2016 to 2023, and there is no uniform regulation on anticoagulation after LAAC. Among the studies we included, 6 studies gave detailed anticoagulation recommendations after LAAC [ 10 – 12 , 14 , 20 , 21 ]. But only one study gave the number of people using each anticoagulant or antiplatelet drug.…”

“…But only one study gave the number of people using each anticoagulant or antiplatelet drug. In Fink et al ’s study, there was a higher rate of use of dual antiplatelet (84.2% vs. 64.9%) and a lower rate use of anticoagulant (12.3% vs.35.1%) in the end-stage renal disease (ESRD) group compared with the non-ESRD group [ 12 ].…”

“…Based on the studies we included, patients with estimated glomerular filtration rate (eGFR)<60 mL/min/1.73 m2 were categorized as having a chronic kidney disease (CKD), and end-stage renal disease (ESRD) was defined as the eGFR < 15 ml/min/1.73 m2 or chronic hemodialysis treatment [ 11 , 12 ].…”

Vorhofflimmern – Was ist bei chronischer Nierenerkrankung und Hämodialyse zu beachten?

“…Wie die antithrombotische Therapie nach Verschluss gehandhabt werden soll, ist noch nicht randomisiert untersucht worden. Zudem muss die Wirksamkeit und Sicherheit des Vorhofohrverschlusses in randomisierten Studien besser evaluiert werden [ Registerdaten deuten auf ein vergleichbares Sicherheitsprofil des Verfahrens bei höhergradiger CKD hin [17,18].…”