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Updated: Aug 23, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Sex Differences in Periprocedural and Long-Term Outcomes Following Transcatheter Left Atrial Appendage Occlusion: A
Sheetal Vasundara Mathai1, Sumit Sohal2, Elie Flatow1
1Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America.
Insights
Women undergoing left atrial appendage occlusion (LAAO) face higher periprocedural risks, including stroke and mortality. However, long-term outcomes after LAAO show no significant sex-based differences in stroke or mortality risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Atrial fibrillation (AF) increases stroke risk, making left atrial appendage occlusion (LAAO) a key intervention for patients unsuitable for anticoagulation.
- Systematic evaluation of sex-based differences in LAAO outcomes is crucial for personalized patient care.
- Previous studies have not comprehensively analyzed sex disparities in LAAO efficacy and safety.
Approach:
- A systematic review and meta-analysis of 16 studies involving 111,775 patients (40.7% women) was conducted.
- Electronic databases (PubMed, Embase, Web of Science) were searched up to March 2022 for LAAO outcome data.
- Primary outcomes included periprocedural stroke, bleeding, pericardial events, and mortality; secondary outcomes assessed long-term risks.
Key Points:
- Women experienced significantly higher risks of periprocedural stroke (RR 1.85), major bleeding (RR 1.63), and mortality (RR 1.94) compared to men.
- Pericardial complications were also more frequent in women (RR 1.80).
- No significant sex differences were observed in long-term risks of stroke, major bleeding, device-related thrombus, or mortality.
Conclusions:
- Women undergoing LAAO have a higher risk of periprocedural complications than men.
- These increased periprocedural risks in women do not appear to persist into long-term follow-up.
- LAAO remains a viable stroke prevention strategy in AF, but sex-specific risk stratification for periprocedural events warrants further investigation.
Background:
Atrial fibrillation (AF) is among the most common arrhythmias associated with an increased risk of cardioembolic phenomena, including stroke. Percutaneous left atrial appendage occlusion (LAAO) has proven beneficial in reducing stroke and mortality in patients with atrial fibrillation who have contraindications to anticoagulation. However, the sex differences in outcomes following LAAO have not been studied systematically.
Methods:
Electronic databases PUBMED, Embase, and Web of Science were systematically searched until March 2022 for studies evaluating patient outcomes following LAAO for AF. The primary outcomes of interest were the risks of periprocedural stroke, major bleeding, pericardial complications, and all-cause mortality. Secondary outcomes included stroke risks, major bleeding, device-related thrombus, cardiovascular and all-cause mortality on long-term follow-up. A random-effects model meta-analysis was conducted, and heterogeneity was assessed using the I-squared test.
Results:
Sixteen studies were included in the final analysis encompassing 111,775 patients, out of which 45,441 (40.7 %) were women. Women had a significantly higher risk of peri-procedural complications including all-cause mortality [relative risk (RR), 95 % confidence intervals (CI); RR 1.94, 95 % CI 1.40-2.69], stroke [RR 1.85, 95 % CI 1.29-2.67], major bleeding [RR 1.63, 95 % CI 1.08-2.44], and pericardial events [RR 1.80, 95 % CI 1.58-2.05]. However, there were no statistically significant differences between sexes in terms of risk of stroke, major bleeding, device-related thrombus, cardiovascular and all-cause mortality on long-term follow-up.
Conclusion:
Among patients undergoing LAAO implantation, women were at higher risk of periprocedural complications than men. This risk was not significant on long-term follow-up.
