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Early Death After Percutaneous Left Atrial Appendage Closure
Quick Takes
- In this multicenter registry, one out of six recipients of percutaneous left atrial appendage closure (LAAC) died within a year of the procedure.
- Clinical variables such as older age, low BMI, reduced kidney function, diabetes, and heart failure may aid physicians in identifying patients at higher risk of early death who are unlikely to benefit from LAAC.
Study Questions:
What is the incidence of early death and what clinical factors are associated with early death in percutaneous left atrial appendage closure (LAAC) recipients?
Methods:
This was a multicenter registry in Europe and Canada enrolling consecutive patients undergoing LAAC in a period from 2009–2019. Death was considered early if it occurred in the first year after the LAAC procedure.
Results:
A total of 807 patients (mean age, 76 years; mean CHA2DS2-VASc score, 4.5) were included. Early death occurred in 125 (16%) patients. In the multivariable analysis, factors associated with early death after LAAC were older age (hazard ratio [HR], 1.03), lower body mass index (BMI) (HR, 0.92), diabetes (HR, 1.71), prior heart failure (HR, 1.74), and lower estimated glomerular filtration rate (eGFR) (HR, 1.09). There was a stepwise increase in the risk of early death within the first year of LAAC with the combination of different risk factors (up to 49% in the presence of >3 risk factors).
Conclusions:
In this multicenter international registry, close to one in six patients died within the first year of LAAC. Older age, low BMI, impaired eGFR, diabetes, and prior heart failure were independently associated with an increased risk. The risk of early death was approximately 50% in the presence of >3 of these risk factors.
Perspective:
Clinical trials have shown that LAAC has very low periprocedural risk and a high procedural success rate. The present registry data suggest that clinical characteristics such as older age, low BMI, impaired kidney function, diabetes, and heart failure may allow the clinician to identify patients at a particularly high rate of death within a year of LAAC. By and large, the early mortality was associated with multiple comorbidities rather than resulting from procedure-related events. In this study, the reported mortality of 16% at 1 year is significantly higher than in previous reports from both clinical trials and registries. It remains unknown if the clinical factors identified in this real-world setting are confirmed in future analyses. Nonetheless, the manuscript highlights the indispensability of good clinical judgment when considering LAAC in patients with multiple comorbidities. Patient selection matters.
Clinical Topics: Arrhythmias and Clinical EP, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Acute Kidney Injury, Arrhythmias, Cardiac, Atrial Appendage, Atrial Fibrillation, Body Mass Index, Diabetes Mellitus, Geriatrics, Glomerular Filtration Rate, Heart Failure, Risk Factors, Secondary Prevention
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