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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Mid-Term Feasibility of Percutaneous Left Atrial Appendage Occlusion in Elderly Patients with Non-Valvular Atrial
Nobuyuki Fukuda1, Teruhiko Imamura1, Shuhei Tanaka1
1The Second Department of Internal Medicine, University of Toyama, Toyama 930-8555, Japan.
Insights
Left atrial appendage occlusion (LAAO) with the WATCHMAN device is safe and effective for patients 85 and older. This therapy prevents thrombosis and allows for anticoagulant cessation in elderly individuals.
Area of Science:
- Cardiology
- Medical Devices
- Geriatric Medicine
Background:
- Percutaneous left atrial appendage occlusion (LAAO) using the WATCHMAN system is an alternative to anticoagulants for non-valvular atrial fibrillation.
- Elderly patients have a high risk of bleeding and stroke, making them potential candidates for LAAO.
- The efficacy and feasibility of LAAO in elderly patients require further investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of WATCHMAN LAAO therapy in patients aged 85 years and older.
- To compare outcomes of LAAO in elderly patients (≥85 years) versus a younger cohort.
Main Methods:
- A retrospective analysis of 188 patients who underwent WATCHMAN LAAO between June 2020 and March 2023.
- Comparison of safety and efficacy outcomes over a 1-year follow-up period between patients aged ≥85 years and younger patients.
- Assessment of device implantation success, peri-device leaks, device-related thrombosis, and bleeding events.
Main Results:
- Device implantation was successful in all but one patient.
- No significant difference in device-related thrombosis or peri-device leaks (>5 mm) between elderly (≥85 years) and younger cohorts.
- Cumulative incidences of bleeding and thrombotic events were similar between the elderly and younger groups.
- Anticoagulant therapy was discontinued in most patients, irrespective of age.
Conclusions:
- Percutaneous LAAO with the WATCHMAN system demonstrates mid-term feasibility and efficacy in patients aged 85 years and older.
- Outcomes in elderly patients are comparable to those in younger patient cohorts.
- LAAO is a viable therapeutic option for reducing stroke risk in elderly patients with non-valvular atrial fibrillation.
Background:
Percutaneous left atrial appendage occlusion (LAAO) therapy using the WATCHMAN system has been introduced to prevent thrombosis and minimize the use of anticoagulants in patients with non-valvular atrial fibrillation. Given the high risk of bleeding and stroke in elderly patients, these patients would be good candidates for this therapy. However, the efficacy and feasibility of LAAO therapy in elderly patients remains uncertain.
Methods:
Consecutive patients who underwent LAAO therapy using the WATCHMAN system in a large academic center between June 2020 and March 2023 were included. The safety and efficacy of LAAO therapy during the 1-year observation period in patients aged ≥85 years old were compared with those in the younger cohort.
Results:
A total of 188 patients (78.4 ± 6.9 years old, 133 male patients) were included. 34 patients were ≥85 years old, 96 were between 75 and 84 years old, and 58 were <75 years old. The elderly group had a higher CHA2DS2-VASc score and were at greater risk of falling-related bleeding compared with the younger cohort. The device implantations were successful in all patients except for one. During the 1-year observation period, one patient had a peri-device leak >5 mm and there were 6 device-related cases of thrombosis, whose incidence was not significantly different between the groups (p = 0.98). The cumulative incidences of bleeding and thrombotic events in the elderly group were as low as in the younger cohort (p > 0.05 for both). Most anticoagulants were terminated regardless of age.
Conclusion:
The mid-term feasibility and efficacy of percutaneous LAAO therapy using the WATCHMAN system in elderly patients aged ≥85 years were as acceptable as in the younger cohort.
