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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Patients With Larger Left Atrial Appendage Orifice Presented Worse Prognosis Contributed by Acute Heart Failure After

Zhongyuan Ren1, Yixing Zheng1, Jingying Zhang1

  • 1Heart Center, Shanghai Tenth People's Hospital, School of Medicine Tongji University Shanghai China.

Journal of the American Heart Association
|September 14, 2022
PubMed

Insights

Left atrial appendage closure (LAAC) for atrial fibrillation patients with larger LAA orifices shows a worse prognosis, including increased acute heart failure risk. Larger LAA size predicts adverse events, except in specific patient subgroups.

Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Outcomes

Background:

  • Left atrial appendage closure (LAAC) prevents stroke in atrial fibrillation but may compromise left atrial compliance and patient prognosis.
  • The impact of left atrial appendage (LAA) orifice size on post-LAAC outcomes requires further investigation.

Purpose of the Study:

  • To comparatively evaluate the prognosis of LAAC in patients stratified by LAA orifice size.
  • To identify LAA orifice size as a predictor of adverse clinical events following LAAC.

Main Methods:

  • 302 patients undergoing successful LAAC were categorized into four groups based on LAA orifice size measured by transesophageal echocardiography.
  • Clinical outcomes including thromboembolic events, major cardiocerebrovascular adverse events, and acute heart failure (AHF) were analyzed.
  • Propensity-score matching was used to compare outcomes between large and small LAA orifice groups.

Main Results:

  • Thromboembolic event survival was similar across groups.
  • The largest LAA orifice group exhibited significantly lower survival for major cardiocerebrovascular adverse events (P<0.001), with a higher incidence of AHF (NYHA class III-IV, 21.4%, P=0.009).
  • A large LAA orifice predicted major cardiocerebrovascular adverse events (HR, 3.749), except in younger patients, those with paroxysmal atrial fibrillation, or failed rhythm/rate control.

Conclusions:

  • Larger LAA orifice size is associated with a worse prognosis after LAAC, characterized by increased AHF incidence.
  • LAA orifice size serves as a predictor for post-LAAC AHF events in most patients, with exceptions noted for specific subgroups.

Keywords:
heart failureleft atrial appendageleft atrial appendage closuremajor adverse cardiocerebrovascular eventsprognosis

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