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

D-PO02-219 - Real-world Clinical Outcomes Comparing Two Common Left Atrial Appendage Closure Devices: Insights From The Israeli Registry (ID 1065)

Abstract

Background: Left atrial appendage (LAA) closure is an alternative approach to chronic oral anticoagulation for the prevention of thromboembolism in patients with atrial fibrillation (AF). However, there is limited data regarding the side-by-side comparison of the two contemporary devices - WATCHMAN (Boston Scientific, Inc.) and AMPLATZER (Abbott Medical, Inc.).
Objective: To compare real-world clinical outcomes for LAA closure using WATCHMAN to those of LAA closure using AMPLATZER in a nationwide, population-based registry.
Methods: We analyzed clinical outcomes of 367 consecutive patients who underwent LAA closure at 8 institutions in Israel. Patients were followed after implantation, according to standard medical practice. Primary endpoints included procedural and long-term data including stroke/embolism, bleeding, and death.
Results: Analyzed patients had a mean age of 76 years and male predominance (63.2%). Leading indications for implant were history of GI bleeding in 150 (40.8%) of patients, history intracranial bleeding in 115 (27.4%) of patients and high risk of bleeding in 112 (30.5%) of patients. WATCHMAN was implanted in 53.9% of patients, and AMPLATZER was implanted in 46.1% of patients. The overall rate of success was 95.3%. 220 patients presented for 6 months’ follow-up transesophageal echocardiography; peri-device leaks > 5 mm was found in one patient (WATCHMAN), device thrombus was found in 4 patients, all of them from the WATCHMAN group. During one year follow up, the subsequent outcomes were found: ischemic stroke - 2(0.5%) (One patient from each group),, major bleeding - 2 (0.5%) (One patient from each group), minor bleeding - 8 (2.2%). The one year mortality rate was 8.2% (30 patients), the five year mortality rate was 11.7% (43 patients), without statistically significant difference between groups.
Conclusion: Within the limitations of the present study, it can be concluded that LAA closure is safe and effective. While procedural success was equally high with both contemporary devices, complications during follow-up were rare, and evenly distributed. The favorable effect of LAA closure on long-term bleeding should be considered when selecting a stroke prevention strategy for patients with nonvalvular AF.
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