Safety of left atrial appendage closure in heart failure patients

Abstract

Introduction: Left atrial appendage closure (LAAC) is an intervention aimed at stroke prevention in nonvalvular atrial fibrillation (AF). There is a three-fold increased risk of stroke in patients with concomitant presence of AF and heart failure (HF). While anticoagulation is effective, only 60% receive it. We aimed at studying the safety of LAAC in HF patients using a national all-payer database.Methods: We queried the National Inpatient Sample for the year 2016-2018 for WATCHMAN device insertion using ICD 10 procedure codes. We divided the study population into HF and non-HF groups. Outcomes were compared using appropriate statistical tests, p< .05 was considered significant.Results: 34 385 LAAC procedures were identified of which 8530 (24.8%) were done in patients with HF. The mean (SD) age of the study population was 76 (7.9) years and 42% were female. There was no difference in mean age between HF and non-HF groups. Our findings indicate that there is no difference in inpatient mortality and cardiac complications between the HF and non-HF groups. However, noncardiac complications including acute kidney injury and respiratory failure were higher in the HF group.Conclusion: LAAC appears to be a safe procedure in patients with HF. The study is limited by a short follow up period and long-term follow-up is required before definitive conclusions can be made.

Interaction of heart failure and stroke: A clinical consensus statement of the ESC Council on Stroke, the Heart Failure Association (HFA) and the ESC Working Group on Thrombosis

“…However, higher incidence of non-cardiac complications such as acute kidney injury and respiratory failure were noted for the HF subgroup. 121 Another study observed during a 3-year follow-up a higher rate of major adverse cardiac and cerebrovascular events (31% vs. 15%) and of death (24% vs. 7%). 122 The impaired outcome was, however, attributed by the authors to the overall adverse outcome due to the HF comorbidity compared to the non-HF group.…”

“…Observational data from over 34 000 LAAC procedures have shown that the use in patients with AF and HF (25% of the LAAC cohort) is safe and there is no difference in inpatient mortality and cardiac complications between the HF and non‐HF subgroups. However, higher incidence of non‐cardiac complications such as acute kidney injury and respiratory failure were noted for the HF subgroup 121 . Another study observed during a 3‐year follow‐up a higher rate of major adverse cardiac and cerebrovascular events (31% vs. 15%) and of death (24% vs. 7%) 122 .…”