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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Occlusion Compared to Anticoagulation in Patients Suffering from Atrial Fibrillation with
Sergio López-Tejero1,2,3, Pablo Antúnez-Muiños1,2,3, Pilar Fraile-Gómez4
1Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca (CAUSA), Universidad de Salamanca (USAL), 37007 Salamanca, Spain.
Insights
Left atrial appendage occlusion (LAAO) is a safe alternative to oral anticoagulation for patients with advanced chronic kidney disease (CKD) and atrial fibrillation. LAAO showed similar efficacy but significantly reduced major bleeding events compared to medical therapy.
Area of Science:
- Cardiology
- Nephrology
- Vascular Surgery
Background:
- Chronic kidney disease (CKD) increases thrombotic and bleeding risks in atrial fibrillation (AF) patients.
- Left atrial appendage occlusion (LAAO) is an emerging alternative to oral anticoagulation (OAC).
- Advanced CKD (eGFR < 30 mL/min/1.73 m² ) presents unique challenges for anticoagulation management.
Purpose of the Study:
- To compare the safety and efficacy of LAAO versus OAC in patients with AF and advanced CKD.
- To evaluate stroke, systemic embolism, transient ischemic attack, and major bleeding events.
- To assess mortality and specific bleeding outcomes in this high-risk population.
Main Methods:
- Retrospective cohort study comparing LAAO (intervention) with OAC (control) in advanced CKD patients.
- Propensity score matching was employed to balance baseline characteristics.
- Primary endpoint: composite of stroke, TIA, SE, and major bleeding. Secondary endpoints: efficacy, major bleeding (BARC ≥ 3), and mortality.
Main Results:
- No significant difference in the primary composite endpoint or efficacy endpoint at 3 years between LAAO and OAC groups.
- LAAO group experienced significantly fewer major bleeding events (BARC ≥ 3) compared to the OAC group (38.3% vs 50%).
- After propensity score matching, the primary composite endpoint was more frequent in the OAC group, suggesting a potential benefit for LAAO.
Conclusions:
- LAAO demonstrates comparable efficacy to OAC in advanced CKD patients with AF.
- LAAO is associated with a significantly lower rate of major bleeding events.
- LAAO represents a viable and potentially safer alternative to OAC for stroke prevention in this specific patient cohort.
Abstract:
Background/Objectives: Chronic kidney disease (CKD) is a significant risk factor for thrombogenic and bleeding events in patients with atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) is increasingly utilized as an alternative to oral anticoagulation. We aimed to compare LAAO against medical therapy in advanced CKD patients (A-CKD). Methods: We conducted a retrospective cohort study to compare patients with AF who had undergone LAAO (intervention group) or patients receiving oral anticoagulation (OAC) (control group). All of them had the diagnosis of A-CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2). The primary endpoint was a composite of stroke, transient ischemic attack (TIA), systemic embolism (SE), and major bleeding. Secondary endpoints included: an efficacy combined endpoint (a composition of stroke, TIA, and SE); major bleedings (defined as Bleeding Academic Research Consortium (BARC) ≥ 3), and mortality at follow-up. A propensity score matching was used to balance the populations. Results: In total, 81 and 102 patients composed the LAAO and anticoagulation groups. Mean age was 78.27 ± 10.3 and 81.2 ± 9.07 (p = 0.069) and female sex was 38.3% and 44.1%, respectively. Patients who underwent LAAO had a higher HAS-BLED score: 3.46 ± 0.85 vs. 3.77 ± 1.06, p = 0.011. Median follow-up was 19.0 months [IQR: 10.9-33.5]. There were no differences in the primary combined endpoint at 3-years follow-up-22.2% vs. 34.2% (hazard ratio (HR) 0.63, CI-95%: 0.353-1.11, p = 0.102)-nor respecting the efficacy combined endpoint: 3.7% vs. 6.9% (HR 0.54, CI-95%: 0.14-2.09, p = 0.355). Patients under anticoagulation treatment did present major bleedings (BARC ≥ 3) more often than the intervention group: 38.3%vs50% (HR 0.52, CI-95%: 0.28-0.96, p = 0.031). A total of 15 patients (14.7%) from the control group underwent LAAO during follow-up. After a propensity score matching analysis, the primary combined endpoint was more frequent in the control group (HR 0.47, CI-95%: 0.25-0.90, p = 0.019). Conclusions: Compared with oral anticoagulation therapy, LAAO had no differences in efficacy, but fewer major bleeding rates were found.
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