Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure

Abstract

AimsThe aim of this study was to observe the percentage of thromboembolic and haemorrhagic events over a 2-year follow-up in patients with non-valvular atrial fibrillation (NVAF) undergoing closure of the left atrial appendage (LAA) with an occlusion device. Observed events and CHADS 2 (congestive heart failure, hypertension, age, diabetes, stroke history), CHA 2 DS 2 -VASc (also adding: vascular disease and sex) and HAS-BLED (hypertension, abnormal liver/renal function, stroke history, bleeding predisposition, labile international normalised ratios, elderly, drugs/alcohol use)-predicted events were compared. Methods LAA closure with an occlusion device was performed in 167 NVAF patients contraindicated for oral anticoagulants and recruited from 12 hospitals between 2009 and 2013. At least two transoesophageal echocardiograms were performed in the first 6 months postimplantation. Antithrombotics included clopidogrel and aspirin. Patients were monitored for death, stroke, major and relevant bleeding and hospitalisation for concomitant conditions. Mean age was 74.68±8.58, median follow-up was 24 months, 5.38% had intraoperative complications and implantation was successful in 94.6% of subjects. Mortality during followup was 10.8%, mostly (9.5%) non-cardiac related. Bleeding occurred in 10.1% of subjects, 5.7% major and 4.4% minor though relevant, and 4.4% suffered stroke. Major bleeding and stroke/transient ischaemic attack events within 2 years (annual event rates, 290 patients/year) were less frequent than expected from CHADS 2 (2.4% vs 9.6%), CHA 2 DS 2 -VASc (2.4% vs 8.3%) and HAS-BLED (3.1% vs 6.6%) risk scores ( p<0.001, p=0.003, p=0.047, respectively). Conclusions LAA closure with an occlusion device in patients contraindicated for oral anticoagulants is a therapeutic option associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year postimplantation.

Percutaneous left atrial appendage occlusion: Effect of device positioning on outcome

“…This conclusion agrees with that of a recent randomized trial, which demonstrated the superiority of LAA occlusion over OAC with warfarin, for preventing the combined outcome of stroke, systemic embolism, and cardiovascular death . Results of a large nonrandomized study of patients contraindicated for oral anticoagulants showed that implantation of the ACP‐occluder was associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year post‐implantation .…”

Convexity Subarachnoid Hemorrhage, Pseudomonas Aeruginosa (PA) Infective Endocarditis and Left Atrial Appendage Occluder (LAAO) Device Infection. A Case Report

“…Two recent studies about feasibility and safety with the fourth generation watchman LAAOs failed to detect device infection [13]. Only one case of infection associated with atrial appendage occluder, occurring a few days after implantation has been reported ( staphylococcus aureus ) and was related to lack of sterile conditions during the procedure [9].…”

Oral anticoagulation and left atrial appendage closure: a new strategy for recurrent cardioembolic stroke

“…However, it is very interesting to note that only 4.6% of the patients were on anticoagulation at the time of their last follow‐up. Similarly, in the Iberian Registry, 7.2% of LAAC procedures were performed on patients who suffered a cardioembolism despite being on anticoagulation treatment . Again, a very small proportion (only 4.1%) of the patients remained anticoagulated 1 year after closure.…”