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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Left atrial appendage occlusion in patients suffering from advanced chronic kidney disease (stage 4 and 5). Long-term
Sergio López-Tejero1,2,3, Pablo Antúnez-Muiños1,2,3, Pilar Fraile-Gómez4
1Department of Cardiology, Complejo asistencial universitario de Salamanca (CAUSA), Salamanca, Spain.
Insights
Left atrial appendage occlusion (LAAO) is effective for preventing strokes in patients with advanced chronic kidney disease (A-CKD). This procedure offers a safe alternative to oral anticoagulation for this high-risk population.
Area of Science:
- Cardiology
- Nephrology
- Interventional Cardiology
Background:
- Patients with advanced chronic kidney disease (A-CKD) and atrial fibrillation face elevated risks of thrombotic and bleeding events.
- Left atrial appendage occlusion (LAAO) presents a potential alternative to oral anticoagulation for preventing thromboembolic events in this population.
Purpose of the Study:
- To evaluate the long-term outcomes of LAAO in patients diagnosed with A-CKD.
- To compare the safety and efficacy of LAAO in patients with and without A-CKD.
Main Methods:
- A comparative study of 573 patients who underwent LAAO between 2009 and May 2022.
- Patients were stratified into two groups: those with A-CKD (eGFR < 30 mL/min/1.73 m²) and those without.
- Long-term follow-up data were analyzed to compare stroke rates, bleeding events, and mortality.
Main Results:
- No significant differences in stroke rates were observed at 1-year or 5-years follow-up between A-CKD and non-A-CKD groups.
- While A-CKD patients experienced more bleeding events, major bleeding (BARC ≥ 3) rates did not differ significantly at 1 or 5 years.
- A-CKD patients showed a higher mortality rate at 5 years (HR: 1.84, p=0.012).
- Global procedural success rate for LAAO was high at 99.1%.
Conclusions:
- LAAO is an effective and safe treatment for preventing ischemic events in patients with A-CKD.
- LAAO serves as a viable alternative to oral anticoagulation for managing atrial fibrillation in high-risk A-CKD patients.
- Despite higher overall bleeding, LAAO demonstrates comparable safety regarding major bleeding events in A-CKD patients.
Introduction And Objectives:
Advanced chronic kidney disease (A-CKD) combined with atrial fibrillation increases the risk of both thrombogenic and bleeding events. Left atrial appendage occlusion (LAAO) may be an alternative to oral anticoagulation to prevent thromboembolic events. We aimed to evaluate the outcomes of LAAO in patients with A-CKD.
Methods:
Comparison at long-term follow-up of patients diagnosed with and without A-CKD (eGFR<30 mL/min/1.73 m2 ) who underwent LAAO between 2009 and May 2022.
Results:
Five hundred seventy-three patients were included. Eighty-one (14%) were diagnosed with A-CKD. There were no differences in sex, age, and cardiovascular risk factors, except for diabetes which was more frequent in patients with A-CKD. The control group had higher rates of stroke, both ischemic and hemorrhagic. There were no differences in the CHA2 DS2 -VASc score, although A-CKD patients had a higher bleeding risk according to the HASBLED scale. Global procedural success was 99.1%. At follow-up, there were no differences in stroke rate: at 1-year (HR: 1.22, IC-95%: 0.14-10.42, p = 0.861); at 5-years (HR: 0.60, IC-95%: 0.08-4.58, p = 0.594). Although bleeding events were higher in the A-CKD group, no differences were found in major bleeding (defined BARC ≥ 3) at 1-year (HR: 1.34, IC-95%: 0.63-2.88, p = 0.464) or at 5-years follow-up (HR: 1.30, IC-95%: 0.69-2.48, p = 0.434). Mortality rate at 5 years was higher in the A-CKD patients (HR: 1.84, IC-95%: 1.18-2.87, p = 0.012).
Conclusions:
LAAO is an effective and safe treatment in A-CKD patients to prevent ischemic events and bleeding. This strategy could be an alternative to oral anticoagulation in this high-risk group of patients.
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