Outcomes of Patients With Reduced Left Ventricular Function Undergoing Left Atrial Appendage Occlusion

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• Transcatheter left atrial appendage occlusion (LAAO) offers stroke prevention for atrial fibrillation patients.
• Patients with reduced left ventricular ejection fraction (LVEF) face higher stroke risk, yet LAAO data in this group is limited.

Purpose of the Study:

• To evaluate LAAO outcomes stratified by LVEF.
• Specifically compare outcomes for LVEF <30% versus LVEF ≥50%.

Main Methods:

• Utilized the National Cardiovascular Data Registry LAAO Registry (2015-2023).
• Included patients ≥18 years with documented LVEF undergoing LAAO.
• Analyzed 1-year outcomes using adjusted logistic and Cox regression models.

Main Results:

• No significant difference in procedural success (98.0% vs 98.1%) or in-hospital mortality for LVEF <30% compared to LVEF ≥50%.
• At 1 year, no difference in stroke or ischemic stroke/arterial thromboembolism for LVEF <30%.
• All-cause mortality was significantly increased in patients with reduced LVEF, particularly those with LVEF <30% (adjusted HR: 1.93).

Conclusions:

• LAAO demonstrates comparable procedural success and safety regarding stroke and major complications in patients with reduced LVEF.
• Reduced LVEF is associated with higher 1-year all-cause mortality, aligning with known heart failure prognosis.
• LAAO is a viable option for selected low LVEF patients, but clinical benefit may be tempered by elevated mortality risk.