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Updated: Jul 12, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Prognostic value of chronic kidney disease in patients undergoing left atrial appendage occlusion
Domenico G Della Rocca1,2, Michele Magnocavallo1,3, Christoffel J Van Niekerk4
1Texas Cardiac Arrhythmia Institute, St.David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA.
Insights
Chronic kidney disease (CKD) increases risks for atrial fibrillation (AF) patients undergoing left atrial appendage occlusion (LAAO). Moderate-to-severe CKD is linked to higher composite endpoint rates, impacting outcomes.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Atrial fibrillation (AF) and chronic kidney disease (CKD) frequently coexist.
- Both conditions increase the risk of thrombo-embolism (TE).
- CKD also predisposes patients to a higher risk of bleeding.
Purpose of the Study:
- To evaluate the prognostic significance of CKD in patients undergoing percutaneous left atrial appendage occlusion (LAAO).
- To assess the impact of varying CKD stages on cardiovascular outcomes after LAAO.
Main Methods:
- Analysis of 2124 consecutive AF patients undergoing LAAO.
- Categorization into CKD stages 1+2, 3, 4, and 5 based on estimated glomerular filtration rate.
- Primary endpoint: composite of cardiovascular mortality, TE, and major bleeding.
- Follow-up period of 13 ± 7 months.
Main Results:
- A non-significant trend towards higher peri-procedural adverse events with worsening CKD.
- Significantly higher incidence of the primary composite endpoint in CKD stages 3, 4, and 5 compared to stages 1+2.
- Left atrial appendage occlusion demonstrated substantial TE risk reduction across all CKD groups.
- Relative risk reduction for major bleeding was observed in all CKD groups.
Conclusions:
- Moderate-to-severe CKD is associated with an increased incidence of the primary composite endpoint in AF patients undergoing LAAO.
- The effectiveness of LAAO in reducing TE risk and the relative risk of major bleeding remained consistent across different CKD severity groups.
Aims:
Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist and share an increased risk of thrombo-embolism (TE). CKD concomitantly predisposes towards a pro-haemorrhagic state. Our aim was to evaluate the prognostic value of CKD in patients undergoing percutaneous left atrial appendage occlusion (LAAO).
Methods And Results:
A total of 2124 consecutive AF patients undergoing LAAO were categorized into CKD stage 1+2 (n = 1089), CKD stage 3 (n = 796), CKD stage 4 (n = 170), and CKD stage 5 (n = 69) based on the estimated glomerular filtration rate at baseline. The primary endpoint included cardiovascular (CV) mortality, TE, and major bleeding. The expected annual TE and major bleeding risks were estimated based on the CHA2DS2-VASc and HAS-BLED scores. A non-significant higher incidence of major peri-procedural adverse events (1.7 vs. 2.3 vs. 4.1 vs. 4.3) was observed with worsening CKD (P = 0.14). The mean follow-up period was 13 ± 7 months (2226 patient-years). In comparison to CKD stage 1+2 as a reference, the incidence of the primary endpoint was significantly higher in CKD stage 3 (log-rank P-value = 0.04), CKD stage 4 (log-rank P-value = 0.01), and CKD stage 5 (log-rank P-value = 0.001). Left atrial appendage occlusion led to a TE risk reduction (RR) of 72, 66, 62, and 41% in each group. The relative RR of major bleeding was 58, 44, 51, and 52%, respectively.
Conclusion:
Patients with moderate-to-severe CKD had a higher incidence of the primary composite endpoint. The relative RR in the incidence of TE and major bleeding was consistent across CKD groups.
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