Clinical outcomes of patients referred for left atrial appendage exclusion who did and did not undergo the procedure

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• Left atrial appendage exclusion (LAAE) offers an alternative to long-term anticoagulation for atrial fibrillation (AF) patients.
• However, not all eligible patients proceed with LAAE due to various constraints.

Purpose of the Study:

• To analyze management strategies and long-term outcomes for patients referred to a multidisciplinary LAAE clinic.
• To include all patients evaluated, whether they underwent LAAE or not.

Main Methods:

• Retrospective analysis of prospectively collected data from 301 AF patients evaluated at a multidisciplinary LAAE clinic (2016-2022).
• LAAE was performed in 168 patients (56%); 133 (44%) did not undergo LAAE due to ineligibility, anatomy, or patient preference.
• CHA2DS2-VASc and HAS-BLED scores were higher in the LAAE group.

Main Results:

• Anticoagulation was discontinued in 94% of Watchman device recipients and 61% of the no-LAAE group.
• At median 2.2-year follow-up, LAAE and no-LAAE groups showed similar rates of death (23% vs 22%), thromboembolic events (8% vs 4%), and bleeding (14% vs 17%).

Conclusions:

• Approximately 50% of patients referred for LAAE did not undergo the procedure and resumed anticoagulation.
• Comprehensive evaluation in a multidisciplinary clinic is crucial for appropriate patient selection and management.