Percutaneous left atrial appendage occlusion: A South African experience

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Atrial fibrillation (AF) increases mortality, heart failure, and stroke risk, often managed with oral anticoagulants (OACs).
• Percutaneous left atrial appendage occlusion (LAAO) offers an alternative thromboprophylaxis for AF patients intolerant, non-adherent, or at high bleeding risk with OACs.
• Previous trials like PROTECT AF demonstrated LAAO's non-inferiority to OACs, but local South African data were scarce.

Purpose of the Study:

• To evaluate the safety and efficacy of a percutaneous LAAO program in South Africa.
• To compare outcomes of the South African LAAO program with established international series.
• To assess the feasibility of LAAO in a Southern African healthcare setting.

Main Methods:

• Analysis of patients undergoing percutaneous LAAO from 2013-2020 at a single South African center.
• Utilized data from an ongoing registry and performed survival analysis with the Kaplan-Meier method.
• Included 101 patients with various forms of AF, focusing on indications, device specifics, procedural success, and adverse events.

Main Results:

• The study included 101 patients (mean age 77 years, 64% male), predominantly with permanent AF (90%).
• The primary indication for LAAO was previous severe bleeding (23%). Procedural success was high (98%) with a mean device size of 23 mm.
• After a median follow-up of 21 months, 6% experienced stroke or all-cause mortality, and 4% had life-threatening complications (tamponade, device embolisation), comparable to international data.

Conclusions:

• Percutaneous LAAO in South Africa demonstrated safety and efficacy comparable to large international studies.
• The findings support the feasibility of establishing and maintaining a successful percutaneous LAAO program within a Southern African context.
• LAAO presents a viable thromboprophylactic option for selected AF patients in South Africa.