Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Left Atrial Appendage Closure D-PO02 - Poster Session II (ID 47) Poster

Abstract

Background: Left atrial appendage occlusion (LAAO) might be particularly attractive in chronic kidney disease (CKD) patients, owing to a high thromboembolic risk and an even higher risk of bleeding.
Objective: We sought to evaluate the safety and effectiveness of LAAO in CKD patients.
Methods: A total of 1238 patients undergoing LAAO at 6 centres were enrolled. On the basis of kidney function, as assessed via the CKD-EPI formula, patients were classified in two groups. Group1 had a GFR value <=60mL/min/1.73m2 (CKD stages 3a-b, 4, and 5), whereas Group2 had a function >60mL/min/1.73m2 (CKD stages 1 and 2). Predicted annual rates of TE or major bleeding events were compared to the annualized observed risk of the two populations.
Results: Compared to Group2 (n=720, 47.5% males), patients in Group1 (n=518, 86.5% males) were older (mean age: 78±8 vs 75±8, p<0.001), and were at higher risk (CHA2DS2-VASc: 4.7±1.4 vs 4.4± 1.4; HAS-BLED: 3.8±1.1 vs 3.2±1.0; p<0.001 for both). Procedural complications (within 7 days) were observed in 3.1% of patients in Group1 and 4.6% of those in Group2 (p=0.18); of them, major procedural adverse events occurred in 10 patients of Group1 [1.9%; 4 gastrointestinal (GI) bleedings, 4 tamponades, 1 myocardial infarction, 1 retroperitoneal hematoma] and in 15 (2.1%; 7 pericardial tamponades, 5 retroperitoneal hematomas, 2 strokes, and 1 GI bleeding) of Group2 (p=0.84). During a mean follow-up of 11.5±7 months (1183 pt/yrs), 10 stroke/TIA (1.9%) and 25 major bleeding events (4.8%; 18 GI and 7 intracranial) were observed in Group1. Rate of TE events was not statistically different between groups (1.9% vs 2.6%; p=0.41); major bleedingS had a significantly higher incidence in Group1 (4.8% vs 2.4%, p=0.02). Based on the estimated annual TE risk according to the CHA2DS2-VASc score (4.76% in Group1 and 4.51% in Group2), the % risk reduction after LAAO was 57.5% and 38.8%, respectively. Based on the estimated annual major bleeding risk based on the HAS-BLED score (7.31% in Group1 and 5.39% in Group2), the % bleeding risk reduction was 30.9% and 54.2%.
Conclusion: LAAO is a safe and effective approach in CKD patients. Given the increased risk of bleeding and contraindications to oral anticoagulation, CKD patients might be good candidates for LAA occlusion.
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