Real-world outcomes of left atrial appendage closure in very elderly compared with younger patients

Left atrial appendage occlusion (LAAO) has become an attractive alternative to chronic anticoagulation in the very elderly with atrial fibrillation (AF). Data on the outcomes and usefulness of this procedure in this population are limited.

The purpose of this study was to analyze the real-world outcomes of LAAO in the very elderly.

The outcomes of LAAO implantation in very elderly patients aged ≥85 years (average 88.1 years) compared with those in younger patients aged <85 years (average 76.7 years), from a single hospital center serving one of the oldest communities in the United States, were retrospectively analyzed. Successful procedures (at implant), procedural complications, 45-day device-related readmission, device-related thrombus (DRT), stroke, and death within 1 year were examined.

A total of 342 LAAO device implantations were performed during the analysis period, with a high success rate of 98.5% and a very low major complication rate of 0.3%. There was no difference in the in-hospital outcomes or complication rates between the 2 groups. The ischemic stroke rate was 2.6% at 1 year and was not significantly different between the groups. The 1-year all-cause mortality was 14.6% in those aged ≥85 years as compared with 7.9% in those aged <85 years (P = .09).

LAAO is as safe and effective in the very elderly as in the younger population and may be performed with a very low complication rate. There is a trend toward increased 1-year mortality in the very elderly.