Sex-Related Differences in Outcomes of Left Atrial Appendage Occlusion Device Placement

Atrial fibrillation (AF) is associated with profound morbidity and mortality, including a fivefold increase in stroke risk. Left atrial appendage occlusion (LAAO) devices have emerged as an alternative approach to anticoagulation in patients with elevated bleeding risk and/or have contraindications to anticoagulation. However, females have been underrepresented in PROTECT & PREVAIL landmark trials supporting LAAO use. We aim to compare gender differences in outcomes of LAAO occlusive devices.

The national readmission database (2016-2020) was utilized to identify hospitalizations for LAAO placement. Cohorts were stratified by gender as males and females. A propensity score matching (PSM) model matched both cohorts. Pearson's x2 test was applied to the matched cohorts to compare outcomes.

Among 89,552 hospitalizations for LAAO placement, 41.3% of procedures were performed in females. Females were found to have a lower prevalence of co-morbidities such as diabetes, hypertension, hyperlipidemia and CKD [p < 0.001]. After propensity matching (N = 20,627), females had higher adverse events, including mortality (0.23% vs. 0.15%, p: 0.041), sudden cardiac arrest (1.77% vs. 1.37%, p: 0.001), pericardial complications (1.46% vs. 0.86%, p < 0.001), cardiac tamponade (0.94% vs. 0.54%, p < 0.001), post-procedural bleeding (0.69% vs. 0.53%, p: 0.032) & net adverse events (4.73% vs. 4.24%, p < 0.001). At six-month follow-up post-procedure, females had higher readmission rates at 30 days (9.42% vs. 8.07%, p < 0.001), 90-day and 180-day intervals (p < 0.001).

In patients with hospitalizations for LAAO device placement, we observed a higher risk of net adverse events and mortality in females following the procedure compared to males. Prospective trials are warranted to identify and stratify the at-risk population with extensive preprocedural evaluation and determine ways to mitigate the sex-related disparities in clinical outcomes following the LAAO procedure.