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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational
Shaojie Han1, Ruikun Jia1, Shenyu Zhao1
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, China.
Insights
Elderly patients (≥75 years) undergoing left atrial appendage closure (LAAC) face higher risks of procedural complications like mortality and bleeding. However, long-term stroke/TIA rates remain similar to younger patients after LAAC.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Left atrial appendage closure (LAAC) is a key therapy for atrial fibrillation (AF).
- Limited data exists on LAAC safety and efficacy in elderly patients (≥75 years).
- This meta-analysis compares procedural complications and long-term outcomes in elderly versus non-elderly patients undergoing LAAC.
Purpose of the Study:
- To investigate procedural complications and long-term outcomes of LAAC in elderly patients compared to non-elderly patients.
- To assess differences in successful implantation rates, periprocedural events, and long-term adverse events.
Main Methods:
- A comprehensive meta-analysis of studies from PubMed, EMBASE, Cochrane Library, and Web of Science.
- Inclusion of 12 studies with 25,094 elderly and 36,035 non-elderly patients.
- Analysis of procedural endpoints (e.g., mortality, bleeding, effusion, stroke, access complications) and long-term outcomes (mortality, bleeding, stroke/TIA).
Main Results:
- Successful LAAC implantation rates were similar between elderly and non-elderly groups.
- Elderly patients showed significantly higher rates of periprocedural mortality, pericardial effusion/tamponade, major bleeding, and vascular access complications.
- Long-term stroke/transient ischemic attack (TIA) rates were comparable between the groups at one-year follow-up.
Conclusions:
- While LAAC implantation success is comparable, elderly patients experience increased periprocedural risks.
- Higher incidences of mortality, bleeding, access complications, and pericardial effusion/tamponade are noted in the elderly.
- LAAC remains a viable option for elderly AF patients, with similar long-term stroke/TIA risk as younger counterparts.
Abstract:
Background: Left atrial appendage closure (LAAC) is an established therapy for patients with atrial fibrillation (AF); however, there is a limited understanding of LAAC in elderly patients (≥75 years old). We conducted a meta-analysis to investigate the procedural complications and long-term outcomes after LAAC in the elderly versus the non-elderly. Methods: We screened PubMed, EMBASE, Cochrane Library, and Web of Science. Procedural endpoints of interest included successful implantation LAAC rates, in-hospital mortality, major bleeding events, pericardial effusion/tamponade, stroke, and vascular access complications related to LAAC. Long-term outcomes included all-cause mortality, major bleeding events, and stroke/transient ischemic attack (TIA) during follow-up. Results: Finally, 12 studies were included in the analysis; these included a total of 25,094 people in the elderly group and 36,035 people in the non-elderly group. The successful implantation LAAC rates did not differ between the groups, while the elderly patients experienced more periprocedural mortality (OR 2.62; 95% CI 1.79−3.83, p < 0.01; I2 = 0%), pericardial effusion/tamponade (OR 1.39; 95% CI: 1.06−1.82, p < 0.01; I2 = 0%), major bleeding events (OR 1.32; 95% CI 1.17−1.48, p < 0.01; I2 = 0%), and vascular access complications (OR 1.34; 95% CI 1.16−1.55, p < 0.01; I2 = 0%) than the non-elderly patients. The long-term stroke/TIA rates did not differ between the elderly and the non-elderly at least one year after follow-up. Conclusions: Even though successful implantation LAAC rates are similar, elderly patients have a significantly higher incidence of periprocedural mortality, major bleeding events, vascular access complications, and pericardial effusion/tamponade after LAAC than non-elderly patients. The stroke/TIA rates did not differ between both groups after at least one-year follow-up.
