Outcomes of percutaneous left atrial appendage occlusion device implantation in atrial fibrillation patients based on underlying stroke risk

Abstract

Aims To determine outcomes in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion (LAAO) based on the underlying stroke risk (defined by the CHA2DS2-VASc score). Methods and results Data were extracted from the National Inpatient Sample for calendar years 2016–20. Left atrial appendage occlusion implantations were identified on the basis of the International Classification of Diseases, 10th Revision, Clinical Modification code of 02L73DK. The study sample was stratified on the basis of the CHA2DS2-VASc score into three groups (scores of 3, 4, and ≥5). The outcomes assessed in our study included complications and resource utilization. A total of 73 795 LAAO device implantations were studied. Approximately 63% of LAAO device implantations occurred in patients with CHA2DS2-VASc scores of 4 and ≥5. The crude prevalence of pericardial effusion requiring intervention was higher with increased CHA2DS2-VASc score (1.4% in patients with a score of ≥5 vs. 1.1% in patients with a score of 4 vs. 0.8% in patients with a score of 3, P < 0.01). In the multivariable model adjusted for potential confounders, CHA2DS2-VASc scores of 4 and ≥5 were found to be independently associated with overall complications [adjusted odds ratio (aOR) 1.26, 95% confidence interval (CI) 1.18–1.35, and aOR 1.88, 95% CI 1.73–2.04, respectively] and prolonged length of stay (aOR 1.18, 95% CI 1.11–1.25, and aOR 1.54, 95% CI 1.44–1.66, respectively). Conclusion A higher CHA2DS2-VASc score was associated with an increased risk of peri-procedural complications and resource utilization after LAAO. These findings highlight the importance of patient selection for the LAAO procedure and need validation in future studies.

Is spontaneous echo contrast associated with device-related thrombus or embolic events after left atrial appendage occlusion? - Insights from the multicenter German LAARGE registry

“…LAARGE addresses these safety events (predominantly minor bleeding events) in a particularly sensitive way, resulting in an allegedly high rate of about 9%. Device embolisms, TIAs, and infections are represented only in isolated cases and are thus extremely rare, comparable to other large registries [ 24 , 25 ]. The reason for an accumulation of pericardial effusions not requiring intervention in the SEC + group cannot be named but the increased rate did not derive from a more complex procedure (comparable fluoroscopy time between groups).…”

Mechanisms, predictors, and evolution of severe peri-device leaks with two different left atrial appendage occluders

“…Peri-procedural complication rates were also similar regardless of PDL status in both device groups. As demonstrated by Messele et al ., 23 high CHA 2 DS 2 -VASc scores (>4) could have also increased the risk of peri-procedural complications such as PDL although CHA 2 DS 2 -VASc scores and in-hospital adverse events were similar regardless of PDL status and devices used in this analysis.…”

In-hospital safety outcomes of left atrial appendage occlusion in octogenarians and nonagenarians

“… 27 Similarly, among patients undergoing LAAO, the presence of heart failure was associated with prolonged LOS and higher hospitalization costs, 28 the presence of cirrhosis was associated with higher rates of 30-day readmission, 29 and the presence of a higher CHA 2 DS 2 -VASc score was associated with an increased risk of peri-procedural complications and resource utilization. 30 Female sex has also been associated with worse in-hospital outcomes following LAAO compared with men. 31 …”