There was no significant difference in procedural success, major in-hospital complications or stroke at one year in patients undergoing transcatheter left atrial appendage occlusion (LAAO) with reduced LVEF; however, these patients did exhibit higher mortality at one year, according to a recent study published in JACC: Clinical Electrophysiology.

Including 186,085 patients (2.8% with LVEF <30%) captured by ACC's LAAO Registry between December 2015 and December 2023, Angela Y. Higgins, MD, et al., compared outcomes following LAAO through one year stratified by LVEF.

Results showed no significant difference in procedural success (98.0% for LVEF <30% vs. 98.1% for LVEF ≥50%; p=0.12) or in-hospital mortality (adjusted odds ratio, 1.39; 95% CI, 0.76-2.55).

Outcomes at one year revealed no difference in stroke (adjusted hazard ratio [aHR], 1.10; 95% CI, 0.88-1.37) or ischemic stroke/arterial thromboembolism (aHR, 1.26; 95% CI, 0.94-1.68). "These findings suggest that patients with severely reduced LVEF have similarly low stroke risk after LAAO at one year as those with preserved LVEF, despite a baseline higher thromboembolic risk," state Higgins and colleagues.

Risk of all-cause mortality at one year significantly increased with every 10% reduction in LVEF. The highest risk was seen in patients with LVEF <30% (adjusted HR, 1.93; 95% CI, 1.75-2.12). "It is well known that patients with reduced left ventricular systolic function have an increased risk of mortality that is inversely related to LVEF," note the authors. "The current study found a similar increased risk of mortality through one year of follow-up based on LVEF...the most common cause of death in patients with severely reduced LVEF was heart failure."