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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous closure of the left atrial appendage in patients with diabetes mellitus
Obayda Azizy1, Christos Rammos1, Nils Lehmann2
11 West-German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University of Duisburg-Essen, Essen, Germany.
Insights
Percutaneous left atrial appendage closure is a safe and effective treatment for preventing thrombo-embolism in patients with diabetes mellitus. This procedure shows similar outcomes in diabetic patients compared to non-diabetic patients, despite their higher baseline risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diabetes Mellitus Research
Background:
- Left atrial appendage closure (LAAC) is a key strategy for preventing atrial fibrillation-related thrombo-embolism.
- Patients with diabetes mellitus (DM) face elevated risks in percutaneous cardiac interventions.
- This study investigates the safety and efficacy of LAAC in diabetic patients.
Purpose of the Study:
- To assess the safety and effectiveness of percutaneous left atrial appendage closure (LAAC) in patients with diabetes mellitus.
- To compare outcomes of LAAC between patients with and without diabetes mellitus.
Main Methods:
- An open-label, single-centre observational study included 78 patients undergoing LAAC.
- Patients were stratified into diabetic (n=31) and non-diabetic (n=47) groups.
- Risk scores (CHA2DS2-VASc, HAS-BLED, Euro II, STS) and procedural/follow-up outcomes were analyzed.
Main Results:
- Diabetic patients exhibited higher thrombo-embolic and bleeding risks (CHA2DS2-VASc, HAS-BLED) and pre-procedural risk scores (Euro II, STS).
- Procedural success rates were similar between groups.
- No significant difference in periprocedural major adverse cardiac and cerebrovascular events, bleeding complications, stroke, left atrial appendage flow velocity, or post-interventional leakage was observed at 6-month follow-up.
Conclusions:
- Percutaneous LAAC is safe and effective in patients with diabetes mellitus.
- Outcomes of LAAC are comparable between diabetic and non-diabetic patients, even with higher baseline risks in the diabetic cohort.
Background:
Left atrial appendage closure is a preventive treatment of atrial fibrillation-related thrombo-embolism. Patients with diabetes mellitus have increased risk for a negative outcome in percutaneous cardiac interventions. We assessed whether percutaneous left atrial appendage closure is safe and effective in patients with diabetes mellitus.
Methods:
We included 78 patients (mean age of 74.4 ± 8.3 years) with indication for left atrial appendage closure in an open-label observational single-centre study.
Results:
Patients with diabetes mellitus ( n = 31) were at higher thrombo-embolic and bleeding risk (CHA2DS2-VASc: 4.5 ± 0.9, HAS-BLED: 4.7 ± 0.7) compared to patients without diabetes mellitus ( n = 47, CHA2DS2-VASc: 3.5 ± 1.0, HAS-BLED: 4.1 ± 0.8; p < 0.001 for both). Pre- and periprocedural risk was elevated in patients with diabetes mellitus (Euro II-Score: 6.6 ± 3.7 vs 3.9 ± 1.9, p < 0.01; Society of Thoracic Surgeons (STS)-Score: 4.0 ± 2.5 vs 2.6 ± 1.2, p < 0.01). Procedural success was similar. Periprocedural major adverse cardiac and cerebrovascular events occurred in one patient from the control group (2.1%), whereas patients with diabetes mellitus had no events ( p = 0.672). Follow-up of 6 months revealed no bleeding complication in both groups. No stroke occurred in follow-up, and left atrial appendage flow velocity reduction (55.6 ± 38.6 vs 51.4 ± 19.1 cm/s, p = 0.474) and rate of postinterventional leakage in the left atrial appendage were comparable (0% vs 2.1%, p = 0.672).
Conclusion:
Despite patients with diabetes mellitus are high-risk patients, the outcome of percutaneous left atrial appendage closure is similar to patients without diabetes mellitus.
