Causes of death and morbidity in patients with atrial fibrillation after left atrial appendage occlusion

Abstract

Background Left atrial appendage occlusion (LAAO) is a safe and effective alternative for stroke prevention in patients with atrial fibrillation (AF). However, there is little literature on the exact causes of death and adverse events during follow-up after LAAO. aims The primary aim of this study was to evaluate survival free of any serious adverse events and of any-cause death in midterm follow-up. The secondary aims were to analyze causes of mortality and further hospitalization as well as adverse events, thromboembolism, and bleeding risk reduction during follow-up. methods A retrospective, single-center study was performed in 84 consecutive patients with AF who underwent LAAO with endocardial occluders. The mean (SD) CHADS 2 score was 3.5 (1.1), CHA 2 DS 2-VASc score, 5.0 (1.5), and HAS-BLED score, 4.4 (0.9). After LAAO, dual 6-month antiplatelet therapy and then lifelong aspirin monotherapy was recommended. Mean (SD) follow-up was 25.3 (13.2) months with an accumulated total follow-up of 174.6 patient-years. results The annual mortality rate was 12.02%. More than half of deaths (57%) were due to noncardiovascular causes with leading malignancy. Survival at the end of the periprocedural period was 98.8%, at 3 months, 97.6%, at 6 months, 95.2%, at 12 months, 86.5%, at 18 months, 85.1%, and at 24 months, 80.6%. The average annual thromboembolic event rate was 2.87%. The most common adverse event was severe bleeding with an annual rate of 6.3% (3 cases while receiving dual antiplatelet therapy and 6 cases while receiving aspirin). conclusions The majority of deaths were not related to stroke in patients with AF after LAAO. Mortality in first 2 years following the procedure was predominantly from noncardiovascular causes.

Endocardial versus epicardial left atrial appendage exclusion for stroke prevention in patients with atrial fibrillation: Midterm follow‐up

“…Secondly, patients in Endocardial Group were significantly older and with multimorbidity, as evidenced of 18.2% cases of noncardiovascular mortality, with malignancy being leading cause of death. Causes of death and morbidity following Endocardial LAAC were discussed in detail in our previous report 34 . Therefore, we would like to strongly emphasize, that based on the current results, it cannot be concluded that mortality after endocardial approach is higher.…”

Clinical follow-up of left atrial appendage occlusion in patients with atrial fibrillation ineligible of oral anticoagulation treatment—a systematic review and meta-analysis

“…Out of the 29 included studies, 27 reported the number of deaths in their studies. The incidence rates of all-cause death ranged from zero [ 22 , 25 , 28 , 32 ] to 11.4 events per 100 patient-years [ 18 ] (Fig. 4 ).…”

Why should cardiac surgeons occlude the left atrial appendage percutaneously?

“…In the last decades, the LAAO procedure emerged as an alternative method for stroke prevention 17 . Multiple observational studies point to the feasibility and safety of percutaneous endocardial and epicardial LAAO procedures, and present long‐term effectiveness in thromboembolism and bleeding risk reduction, even in high‐risk patients 16,18‐20 . Recently, the class of recommendations of percutaneous LAAO procedure was upgraded, and currently, both European and American guidelines recommend percutaneous LAAO procedure as an alternative treatment for patients with a high risk of stroke and contraindications for long‐term OAC use (Class IIb, Level of Evidence B) 6,7,21 .…”