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Updated: Jul 14, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage closure in very elderly patients in the French National Registry
Emmanuel Teiger1,2, Romain Eschalier3,4, Nicolas Amabile5
1Department of Cardiology, APHP, Henri Mondor University Hospital, Créteil, France.
Insights
Left atrial appendage closure (LAAC) is safe and effective for reducing stroke risk in atrial fibrillation patients, including octogenarians. While older patients had higher mortality, thromboembolic event rates were similar across age groups.
Area of Science:
- Cardiology
- Vascular Medicine
- Geriatric Medicine
Background:
- Left atrial appendage closure (LAAC) is a recommended stroke risk reduction strategy for patients with atrial fibrillation who have contraindications to anticoagulation.
- Limited age-stratified data exist for LAAC, particularly concerning outcomes in the oldest patient populations.
Purpose of the Study:
- To evaluate the safety and efficacy of LAAC in a broad patient population.
- To specifically analyze LAAC outcomes in patients aged 80 years and older compared to younger patients.
Main Methods:
- A nationwide, prospective, multicentre observational registry involving 53 French cardiology centres from 2018-2021.
- The primary composite endpoint included ischaemic stroke, systemic embolism, and unexplained or cardiovascular death.
- Patients were stratified into two groups: <80 years and ≥80 years for comparative analysis.
Main Results:
- Among 1053 patients, 48.6% were ≥80 years old. Procedure-related serious adverse events were non-significantly higher in octogenarians (7.0% vs 4.4%).
- Despite higher CHA₂DS₂-VASc scores in octogenarians, thromboembolic event rates were similar between age groups (3.0 vs 3.1/100 patient-years).
- All-cause mortality was significantly higher in octogenarians (15.3% vs 10.1%), driven by non-cardiovascular deaths. The primary endpoint rate did not differ significantly between age groups.
Conclusions:
- Left atrial appendage closure demonstrates similar efficacy in preventing thromboembolic events for both octogenarian and younger patients with atrial fibrillation.
- While LAAC is effective across age groups, octogenarians experienced higher all-cause mortality, primarily from non-cardiovascular causes.
Objective:
Left atrial appendage closure (LAAC) is recommended to decrease the stroke risk in patients with atrial fibrillation and contraindications to anticoagulation. However, age-stratified data are scarce. The aim of this study was to provide information on the safety and efficacy of LAAC, with emphasis on the oldest patients.
Methods:
A nationwide, prospective, multicentre, observational registry was established by 53 French cardiology centres in 2018-2021. The composite primary endpoint included ischaemic stroke, systemic embolism, and unexplained or cardiovascular death. Separate analyses were done in the groups <80 years and ≥80 years.
Results:
Among the 1053 patients included, median age was 79.7 (73.6-84.3) years; 512 patients (48.6%) were aged ≥80 years. Procedure-related serious adverse events were non-significantly more common in octogenarians (7.0% vs 4.4% in patients aged <80 years, respectively; p=0.07). Despite a higher mean CHA2DS2-VASc score in octogenarians, the rate of thromboembolic events during the study was similar in both groups (3.0 vs 3.1/100 patient-years; p=0.85). By contrast, all-cause mortality was significantly higher in octogenarians (15.3 vs 10.1/100 patient-years, p<0.015), due to a higher rate of non-cardiovascular deaths (8.2 vs 4.9/100 patient-years, p=0.034). The rate of the primary endpoint was 8.1/100 patient-years overall with no statistically significant difference between age groups (9.4 and 7.0/100 patient-years; p=0.19).
Conclusion:
Despite a higher mean CHA2DS2-VASc score in octogenarians, the rate of thromboembolic events after LAAC in this age group was similar to that in patients aged <80 years.
Trial Registration Number:
ClinicalTrials.gov Registry (NCT03434015).
