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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Impact of Immunosuppressive Drugs on Patients With Percutaneous Left Atrial Appendage Occlusion

Daisuke Togashi1, Christopher R Ellis1, Zachary T Yoneda1

  • 1Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Journal of Cardiovascular Electrophysiology
|August 29, 2025
PubMed

Insights

Percutaneous left atrial appendage closure (LAAC) is safe for patients on immunosuppressive therapy (IMS). While perioperative outcomes are similar, these patients face higher systemic infection rates and reduced improvement in peri-device leak during follow-up.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Percutaneous left atrial appendage closure (LAAC) is a stroke risk reduction strategy for non-valvular atrial fibrillation patients unable to use oral anticoagulation.
  • Outcomes of LAAC in patients on chronic immunosuppressive therapy (IMS) are not well-established.

Purpose of the Study:

  • To evaluate the safety and efficacy of percutaneous LAAC in patients receiving chronic IMS.
  • To compare perioperative and long-term outcomes between patients on IMS and those not on IMS.

Main Methods:

  • Retrospective evaluation of 1172 patients undergoing LAAC from November 2017 to March 2023.
  • Patients were categorized based on the use of long-term immunosuppressive therapy (IMS).
  • Analysis included perioperative complications, clinical outcomes, and device follow-up characteristics, including peri-device leak (PDL) and device-related thrombus.

Main Results:

  • No significant difference in intraoperative complications between IMS and non-IMS groups (1.4% vs. 1.3%).
  • Higher incidence of systemic infections in the IMS group during a median follow-up of 617 days (25.0% vs. 6.1%).
  • No significant difference in peri-device leak (PDL) or device-related thrombus, but lower PDL improvement in the IMS group (8.3% vs. 50.0%).

Conclusions:

  • Percutaneous LAAC can be successfully performed in patients on chronic IMS without increasing perioperative risks.
  • Long-term follow-up reveals an increased risk of systemic infections in patients on IMS after LAAC.
  • IMS use is associated with diminished improvement in peri-device leak over time.
Abstract

Keywords:
device‐related thrombusimmunosuppressive drugleft atrial appendage closurenon‐valvular atrial fibrillationperi‐device leak

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