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

Transcatheter left atrial appendage occlusion (LAAO) is an alternative treatment to prevent stroke in patients with atrial fibrillation. Patients with reduced left ventricular ejection fraction (LVEF) represent a particularly high-risk population for stroke, but data on LAAO for these patients are limited.

The objective of this study was to evaluate outcomes after LAAO stratified according to LVEF (<30%, 30%-39%, 40%-49%, and ≥50%).

The National Cardiovascular Data Registry LAAO Registry was used to identify patients ≥18 years of age with a documented LVEF who underwent LAAO from December 2015 to December 2023. Outcomes through 1 year stratified according to LVEF were evaluated by using adjusted logistic regression and Cox proportional hazards regression (reference group: LVEF ≥50%).

The study included 186,085 patients (5,192 [2.8%] with an LVEF <30%). There was no difference in procedural success (98.0% for LVEF <30% vs 98.1% for LVEF ≥50%; P = 0.12) or in-hospital mortality for LVEF <30% (adjusted OR: 1.39; 95% CI: 0.76-2.55). At 1 year, there was no difference in any stroke (adjusted HR: 1.10; 95% CI: 0.88-1.37) or ischemic stroke/arterial thromboembolism (adjusted HR: 1.26; 95% CI: 0.94-1.68) for patients with LVEF <30% compared with LVEF ≥50%. All-cause mortality was significantly increased for every 10% reduction in LVEF at 1 year, with the highest risk in those with an LVEF <30% (adjusted HR: 1.93; 95% CI: 1.75-2.12).

For patients with a reduced LVEF, there was no significant difference in procedural success or major in-hospital complications. There was also no significant difference in stroke through 1 year of follow-up. Patients with a reduced LVEF had higher 1-year mortality, consistent with the known prognosis of patients with heart failure with reduced LVEF. These findings suggest that LAAO is reasonably safe and effective for selected patients with low LVEF, although the net clinical benefit may be attenuated due to the high risk of mortality.