Indications and Outcome in Patients Undergoing Left Atrial Appendage Closure—The Austrian LAAC Registry

Background: Complete real-world data on the indications and outcomes of left atrial appendage closure (LAAC) outside of clinical trials are rare. In this study, we stratified patients undergoing LAAC by indication groups. Methods: This analysis of the national multicentre Austrian LAAC Registry comprised all patients that underwent LAAC up until 2018 at the currently active centres in Austria. The baseline characteristics, procedural details and outcomes between the following indication groups were compared: bleeding as an indication for LAAC (“bleeding” group) vs. thromboembolism despite oral anticoagulation (OAC; “thromboembolism” group) vs. an intolerance to OAC for reasons other than the above (“other” group). Results: The analysis included 186 patients, with 59.7% in the “bleeding” group, 8.1% in the “thromboembolism” group and 32.2% in the “other” group. The CHADS2 score was the highest in the “thromboembolism” group and the HAS-BLED score was the highest in the “bleeding” group. The procedural outcomes were similar between groups (implantation success, 97.3%), with major complications occurring in 7.0% of patients. One-year survival free from stroke, bleeding or LAAC-associated hospitalisation was 83.9%, 90.0% and 81.4% in the “bleeding”, “thromboembolism” and “other” groups, respectively (p = 0.891). Conclusions: In routine clinical practice, LAAC was used in a heterogeneous patient population with atrial fibrillation (AF) and contraindication, inefficacy or intolerance to OAC. The long-term outcome was favourable in all groups.

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Left Atrial Appendage Closure with Amplatzer Cardiac Plug in Nonvalvular Atrial Fibrillation: Safety and Long-Term Outcome

Arquivos Brasileiros de Cardiologia ◽

10.5935/abc.20170167 ◽

2017 ◽

Author(s):

Marcio José Montenegro da Costa ◽

Esmeralci Ferreira ◽

Edgard Freitas Quintella ◽

Bernardo Amorim ◽

Alexandre Fuchs ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Left Atrial Appendage Closure ◽

Nonvalvular Atrial Fibrillation ◽

Term Outcome ◽

Long Term Outcome

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Interventional occlusion of left atrial appendage in patients with atrial fibrillation. Acute and long-term outcome of occluder implantation in the LAARGE Registry

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-019-00635-7 ◽

2019 ◽

Vol 58 (3) ◽

pp. 273-280 ◽

Cited By ~ 4

Author(s):

Johannes Brachmann ◽

Thorsten Lewalter ◽

Ibrahim Akin ◽

Horst Sievert ◽

Volker Geist ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Term Outcome ◽

Long Term Outcome

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Influence of severe anemia on procedural safety and one-year outcome after left atrial appendage closure: Insights from a very high-risk cohort

IJC Heart & Vasculature ◽

10.1016/j.ijcha.2021.100946 ◽

2022 ◽

Vol 38 ◽

pp. 100946

Author(s):

Shinwan Kany ◽

Johannes Brachmann ◽

Thorsten Lewalter ◽

Ibrahim Akin ◽

Horst Sievert ◽

...

Keyword(s):

High Risk ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Severe Anemia ◽

Left Atrial Appendage Closure ◽

One Year ◽

Very High ◽

High Risk Cohort

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Abstract 14157: Racial Differences in Outcomes of Ischemic Stroke and Mortality With Left Atrial Appendage Closure With Watchman Device in Medicare Population

Circulation ◽

10.1161/circ.142.suppl_3.14157 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Rajesh Kabra ◽

Saket Girotra ◽

Mary S Vaughan Sarrazin

Keyword(s):

Ischemic Stroke ◽

Racial Differences ◽

Risk Adjustment ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Left Atrial Appendage Closure ◽

Medicare Population ◽

Watchman Device ◽

One Year

Introduction: Left atrial appendage closure by Watchman implantation is a novel non-pharmacological alternative for stroke prevention in non-valvular atrial fibrillation (AF) patients who are deemed unable to take long term anticoagulation. Blacks and Hispanics were under-represented in the clinical trials for Watchman device and therefore more outcome data is needed in these populations. Hypothesis: We sought to study racial differences in outcomes of mortality and ischemic stroke in Medicare beneficiaries who received a Watchman device Methods: Medicare claims were used to identify 13,598 patients with AF who underwent Watchman implantation during January 2015 to November 2017. Patient demographics including race and comorbid conditions were identified based on the hospital discharge record. Death and readmission rate for ischemic strokes and transient ischemic attacks (TIA’s) were assessed. Primary readmission diagnoses were classified using the AHRQ Clinical Classification Software. Results: The mean age of patients was 78±6.3 years and 40.3% were female. There were 11,955 whites (88%), 453 blacks (3.3%) and 523 Hispanic patients (3.8%). Mean CHAD 2 S 2 VASc score was 4.7 in blacks, 4.6 in Hispanics and 4.5 in whites. One year mortality after watchman implantation was 6.8% in blacks, 8% in Hispanics and 7.69% in whites. After risk adjustment, compared to whites, the Hazard Ratio for death was 0.82 in blacks (p=0.31) and 0.96 in Hispanics (p=0.82). The rate of ischemic stroke and TIA following Watchman implantation was highest at 4.75 per 100 patient years in blacks followed by 2.87 per 100 patient years in Hispanics and 2.37 per 100 patient years in whites. After risk adjustment, blacks continued to have higher risk for ischemic stroke (HR 1.87, p = 0.01) compared to whites, while Hispanics had a similar risk (HR 1.19, p=0.51). Conclusions: In the Medicare population undergoing Watchman implantation, after risk adjustment, one year mortality following the procedure was similar in whites, Hispanics and blacks. However, the rate of ischemic stroke was significantly higher in blacks compared to whites even after risk adjustment. Further studies are needed in the real world to monitor the outcomes associated with watchman device in minority population.

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