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Left Atrial Appendage Occlusion in the Elderly
Quick Takes
- Despite the higher 5-year event rates, elderly patients derive similar benefits from left atrial appendage occlusion (LAAO) as their younger counterparts.
- Age alone should not preclude the consideration of LAAO in otherwise suitable candidates.
Study Questions:
What is the safety and efficacy of left atrial appendage occlusion (LAAO) in elderly patients?
Methods:
The authors used data from the PROTECT-AF and PREVAIL randomized trials, and the nested registries of the Watchman 2.5 device to compare clinical outcomes following LAAO in two age groups: patients ≥80 and <80 years of age. The primary efficacy endpoint was a composite of cardiovascular (CV)/unknown death, stroke, or systemic embolism (SE) at 5 years. Secondary endpoints included CV/unknown death, stroke, SE, and major and nonprocedural bleeding.
Results:
There were 2,258 patients, of whom 570 (25%) were ≥80 years of age, and 1,688 (75%) were <80 years of age. Procedural complications at 7 days were similar in both age groups. The primary endpoint occurred in 12% vs. 14% in the device vs. control group among patients <80 years of age and in 25% vs. 22% in the device vs. control group among patients ≥80 (interaction p value = 0.48). There was no interaction between age and treatment effect for any of the secondary outcomes. The average treatment effects of LAAO (as compared with warfarin) were similar in the patients who were ≥80 years of age and those of <80 years of age.
Conclusions:
Despite the higher event rates, octogenarians derive similar benefits from LAAO as their younger counterparts. Age alone should not preclude LAAO in otherwise suitable candidates.
Perspective:
As patients with atrial fibrillation age, their risk of stroke or SE increases, but also their frailty and comorbidities. Thus, patients with the highest potential to benefit from LAAO are also who may have the highest risk of complication. Prior studies suggest as much. The strength of the present study lies in the availability of a control arm (warfarin) and the study’s long prospective follow-up of 5 years. Of note is the fact that all of the studied patients who underwent LAAO received the Watchman 2.5 device, not the current-generation FLX, which has replaced its predecessor.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiovascular Care Team, Geriatric Cardiology, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Aged, 80 and over, Anticoagulants, Arrhythmias, Cardiac, Atrial Appendage, Atrial Fibrillation, Coronary Occlusion, Embolism, Frailty, Geriatrics, Hemorrhage, Myocardial Infarction, Stroke, Vascular Diseases, Warfarin
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