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Updated: Jun 27, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Trends in percutaneous left atrial appendage occlusion and 1-year mortality 2013-2021: A nationwide observational
Olivia J Madsen1, Morten Lamberts1, Jonas B Olesen1
1Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark.
Insights
Percutaneous left atrial appendage occlusion (LAAO) use has shifted towards patients with lower comorbidity. Indications are changing, with increased use in those without prior events, highlighting the need for careful patient selection in LAAO procedures.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Procedures
Background:
- Percutaneous left atrial appendage occlusion (LAAO) is a growing stroke prevention strategy for atrial fibrillation patients with anticoagulant complications.
- Real-world data on evolving patient profiles and LAAO indications are limited.
Purpose of the Study:
- To analyze trends in patient characteristics and indications for LAAO from 2013 to 2021.
- To assess changes in patient comorbidities and reasons for LAAO procedures over time.
Main Methods:
- A retrospective analysis of 1465 patients undergoing LAAO in Denmark between 2013 and 2021.
- Patients were stratified into three-year groups (2013-2015, 2016-2018, 2019-2021) to evaluate temporal changes.
- Indications analyzed included prior bleeding, stroke/systemic embolism, and other reasons, alongside 1-year mortality.
Main Results:
- Patient age remained stable (around 75 years), but comorbidity burden decreased significantly (e.g., CHA2DS2-VASc ≥4 from 56.7% to 40.3%).
- The proportion of LAAO procedures for 'other indications' increased substantially (26.9% to 44.7%), while indications for prior stroke/SE or non-intracerebral bleeding decreased.
- One-year mortality varied by indication, with higher rates for non-intracerebral bleeding (11.3%) compared to other indications (6.2%).
Conclusions:
- The patient profile undergoing LAAO has evolved, with a trend towards lower comorbidity.
- LAAO is increasingly utilized in patients without a history of clinical events.
- Mortality rates differ based on the indication for LAAO, emphasizing the need for careful patient selection and ongoing real-world data analysis.
Background:
Percutaneous left atrial appendage occlusion (LAAO) is increasingly used for stroke prevention in patients with atrial fibrillation and anticoagulant-related complications. Yet, real-life studies evaluating changes in patient characteristics and indications for LAAO remain scarce.
Methods:
To evaluate changes in patient characteristics and indications for LAAO defined as 2-year history of intracerebral bleeding, any ischemic stroke/systemic embolism (SE), any non-intracerebral bleeding, other indication, and 1-year mortality. All patients undergoing percutaneous LAAO in Denmark from 2013 to 2021 were stratified into the following year groups: 2013-2015, 2016-2018, and 2019-2021.
Results:
In total, 1465 patients underwent LAAO. Age remained stable (2013-2015: 74 years versus 2019-2021: 75 years). Patients' comorbidity burden declined, exemplified by CHA2DS2-VASc ≥4 and HAS-BLED ≥3 decreased from 56.7% and 63.7% in 2013-2015 to 40.3% and 45.8% in 2019-2021. Indications for LAAO changed over time with other indication comprising 44.7% in 2019-2021; up from 26.9% in 2013-2015. Conversely, fewer patients had an indication of any ischemic stroke/SE (2013-2015: 30.8% vs 2019-2021: 20.3%) or any non-intracerebral bleeding (2013-2015: 29.4% vs 2019-2021: 23.4%). 1-year mortality was 11.3% for any non-intracerebral bleeding and 6.2% for other indication.
Conclusion:
The LAAO patient-profile has changed considerably. Age remained stable, while comorbidity burden decreased during the period 2013-2021. LAAO is increasingly used in patients with no clinical event history and mortality differs according to indication. Selection of patients to LAAO should be done carefully, and contemporary real-life studies investigating clinical practice could add important insights.
