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Updated: Jun 15, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Adverse outcomes with left atrial appendage occlusion device implantation in chronic and end stage kidney disease: A
Gauravpal S Gill1, Shikha Shailly2, Teja Chakrala3
1Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America.
Insights
Patients with kidney disease undergoing left atrial appendage occlusion (LAAO) face higher risks of in-hospital mortality and bleeding. Further research is needed to compare LAAO versus anticoagulation in these high-risk populations.
Area of Science:
- Cardiology
- Nephrology
- Medical Devices
Background:
- Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have a higher risk of bleeding events.
- The safety of percutaneous left atrial appendage occlusion (LAAO) in these patients remains uncertain due to conflicting study results.
Purpose of the Study:
- To evaluate the safety and outcomes of LAAO in patients with and without significant kidney disease.
- To compare the risks of mortality, bleeding, and other complications between CKD/ESRD patients and those without kidney disease undergoing LAAO.
Main Methods:
- A systematic literature search was conducted on PubMed and Google Scholar.
- Eleven studies comparing LAAO outcomes in patients with and without kidney disease were analyzed using a random effects model.
Main Results:
- Data from 61,724 patients revealed an increased risk of in-hospital mortality (OR 2.76) and peri-procedural bleeding (OR 1.51) in patients with kidney disease.
- No significant differences were observed in the risk of stroke, pericardial effusion, vascular complications, or device-related thrombus.
Conclusions:
- Kidney disease is associated with increased risks of mortality and bleeding complications following LAAO.
- Randomized controlled trials are necessary to compare LAAO directly with anticoagulation in CKD and ESRD populations.
Background:
Chronic kidney disease (CKD) and end stage renal disease (ESRD) are associated with increased risk of bleeding events, including hemorrhagic stroke, and periprocedural and gastrointestinal bleeding among patients with atrial fibrillation who are on anticoagulation. Safety of percutaneous left atrial appendage occlusion (LAAO) among this patient population has been uncertain with studies showing contradictory results.
Methods:
PubMed and Google Scholar databases were queried for studies comparing outcomes among patients with and without significant CKD, and with and without ESRD who underwent LAAO device implantation. Data on outcomes from the selected studies were extracted and analyzed using random effects model. Heterogeneity was assessed using I2 test.
Results:
Data from eleven studies with 61,724 patients with and without kidney disease were included in the final analyses. There was an increased risk of in-hospital mortality (OR 2.76, 95 % CI [1.15-6.64]; p = 0.02) and peri-procedural bleeding (1.51 [1.33-1.71]; p < 0.01) associated with kidney disease. There was no significant difference in risk of stroke (1.19 [0.70-2.03]; p = 0.53), pericardial effusion (1.22 [0.77-1.92]; p = 0.40), vascular complications (1.18 [0.92-1.52]; p = 0.20), or device related thrombus (1.13 [0.53-2.40]; p = 0.75).
Conclusions:
This study shows an increased risk of complications among patients with kidney disease, who undergo LAAO device implantation. These findings suggest the need for studies with randomized control design specifically designed to compare outcomes with LAAO versus anticoagulation in the CKD and ESRD populations.
