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Updated: Oct 22, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Impact of HAS-BLED Score on outcome after percutaneous left atrial appendage closure: insights from the German Left
Jakob Ledwoch1,2, Jennifer Franke1, Johannes Brachmann3
1CardioVascular Center Frankfurt, Seckbacher Landstr. 65, 60389, Frankfurt, Germany.
Insights
Left atrial appendage (LAA) closure is effective for stroke prevention in atrial fibrillation (AF) patients. Outcomes after LAA closure were similar for ischemic events but mortality increased with higher HAS-BLED scores.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Percutaneous left atrial appendage (LAA) closure is an established stroke prophylaxis for non-valvular atrial fibrillation (AF) patients with high bleeding risk.
- The impact of the HAS-BLED score on outcomes following LAA closure remains incompletely understood.
Purpose of the Study:
- To evaluate the outcomes of LAA closure in relation to different HAS-BLED score strata.
- To assess the safety and efficacy of LAA closure across varying bleeding risk profiles.
Main Methods:
- A sub-analysis of the prospective, multicenter LAARGE registry.
- Patients were stratified into three groups based on HAS-BLED scores: 0-2 (group 1), 3-4 (group 2), and 5-7 (group 3).
- 1-year composite endpoint of death, stroke, and systemic embolism was analyzed using Kaplan-Meier estimates.
Main Results:
- A total of 633 patients were analyzed.
- The 1-year composite rate of death, stroke, and systemic embolism significantly increased with higher HAS-BLED scores (3.4% in group 1 vs. 10.4% in group 2 vs. 20.1% in group 3; p log-rank < 0.001).
- This difference was primarily driven by mortality, as stroke and systemic embolism rates did not differ significantly. Major bleeding rates were 0%, 0%, and 2.4% at 1 year for groups 1, 2, and 3, respectively (p=0.016).
Conclusions:
- LAA closure demonstrates similarly low rates of ischemic complications at 1 year, irrespective of baseline bleeding risk.
- Higher HAS-BLED scores are associated with increased mortality post-LAA closure, likely due to older age and greater comorbidity burden in these patients.
Aim:
Percutaneous left atrial appendage (LAA) closure has been established as alternative stroke prophylaxis in patients with non-valvular atrial fibrillation (AF) and high bleeding risk. However, little is known regarding the outcome after LAA closure depending on the HAS-BLED score.
Methods:
A sub-analysis of the prospective, multicenter, Left-Atrium-Appendage Occluder Register-GErmany (LAARGE) registry was performed assessing three different groups with respect to the HAS-BLED score (0-2 [group 1] vs. 3-4 [group 2] vs. 5-7 [group 3]).
Results:
A total of 633 patients at 38 centers were enrolled. Of them, 9% (n = 59) were in group 1, 63% (n = 400) in group 2 and 28% (n = 174) in group 3. The Kaplan-Meier estimated 1-year composite of death, stroke and systemic embolism was 3.4% in group 1 vs. 10.4% in group 2 vs. 20.1% in group 3, respectively (p log-rank < 0.001). The difference was driven by death since stroke and systemic embolism did not show a significant difference between the groups. The rate of major bleeding at 1 year was 0% vs. 0% vs. 2.4%, respectively (p = 0.016).
Conclusion:
The present data show that patients had similarly low rates of ischemic complications 1 year after LAA closure irrespective of the baseline bleeding risk. Higher HAS-BLED scores were associated with increased mortality due to higher age and more severe comorbidity of these patients.
