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Updated: May 5, 2026

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Left atrial appendage occlusion study III-Kidney substudy

Kevin S Kim1, Emilie P Belley-Côté2, Michael Walsh2

  • 1Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Perioperative and Surgery Research Program, Population Health Research Institute, Hamilton, Ontario, Canada.

American Heart Journal
|April 21, 2025
PubMed

Insights

Left atrial appendage occlusion effectively reduces stroke risk in patients with atrial fibrillation and chronic kidney disease. This procedure showed consistent benefits across varying kidney function levels without increasing adverse events.

Area of Science:

  • Cardiology
  • Nephrology
  • Medical Devices

Background:

  • Optimal anticoagulation for atrial fibrillation (AF) in chronic kidney disease (CKD) patients remains unclear.
  • The efficacy of left atrial appendage occlusion (LAAO) may vary in CKD patients.
  • This study is a secondary analysis of the LAAOS III trial.

Purpose of the Study:

  • To investigate the effect of LAAO on stroke risk and safety outcomes in patients with AF and varying degrees of kidney function.
  • To determine if baseline kidney function influences the effectiveness of LAAO.

Main Methods:

  • Secondary analysis of the LAAOS III trial (NCT01516151) involving 4,768 participants with AF undergoing cardiac surgery.
  • Estimated Glomerular Filtration Rate (eGFR) calculated using the CKD-EPI 2021 equation.
  • Cox-proportional hazards models used to assess LAAO effects, with kidney function as a continuous and categorical variable.

Main Results:

  • LAAO was associated with a significant reduction in stroke risk (HR 0.67; P = .001) compared to no occlusion, irrespective of eGFR.
  • No significant differences observed in all-cause mortality, cardiovascular deaths, heart failure hospitalizations, major bleeding, or myocardial infarction between groups.
  • No significant interaction between eGFR and LAAO for any outcome.

Conclusions:

  • Surgical LAAO demonstrates consistent efficacy in reducing stroke risk for AF patients with impaired kidney function.
  • LAAO is a safe alternative for stroke prevention in AF patients with CKD, without increasing the risk of major adverse events.
Abstract

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