Decennial Analysis of Interventional Left Atrial Appendage Closure.
BACKGROUND
Data on long-term follow-up (LTFU) after interventional closure of the left atrial appendage (LAAC) in patients with nonvalvular atrial fibrillation (AF) are scarce. We sought to determine the outcome of patients after LAAC with the first generation device.


RESULTS
The Cardioangiologisches Centrum Bethanien (CCB) LAAC registry database was analyzed. Between October 2001 and July 2007, 45 AF patients (23 male, mean age 71 ± 6 years; mean CHA2 DS2 -VaSc 4.3 ± 1.7 [range 1-7]; mean HASBLED score 3.3 ± 1.2 [1-5]) received LAAC. Postimplant dual-platelet inhibition with clopidogrel 75 mg/day and aspirine (ASA) 300 mg/day was prescribed for 6 months, followed by ASA 300 mg indefinitely. The primary endpoint was defined as any thrombembolic complication and/or any bleeding complication. The median FU was 7.4 years (1-12.4 years) resulting in 292 patient years. Fourteen patients died due to heart failure (n = 4), noncardiac reasons (n = 7), or due to unknown etiology (n = 3). No patient died from a bleeding or a stroke. Five ischemic strokes occurred at a median of 794 days (range 304-3,706 days) after LAAC. The observed annual stroke rate was 1.7% (RR 0.43; 95% CI 0.24-0.74; P = 0.0028). In 6 patients bleeding occurred (2 acute procedural, 4 during follow-up). The observed annual bleeding rate was 2.1% (RR 0.56; 95% CI 0.48-0.66; P < 0.0001).


CONCLUSIONS
During LTFU after LAAC in patients with nonvalvular AF, lower event rates than expected are observed for both thrombembolic and bleeding complications.
Cardioangiologisches Centrum Bethanien, Frankfurt/M., Germany.
Boris
B
Schmidt
Cardioangiologisches Centrum Bethanien, Frankfurt/M., Germany.
Stefano
S
Bordignon
Cardioangiologisches Centrum Bethanien, Frankfurt/M., Germany.
Alexander
A
Fuernkranz
Cardioangiologisches Centrum Bethanien, Frankfurt/M., Germany.
Laura
L
Perrotta
Cardioangiologisches Centrum Bethanien, Frankfurt/M., Germany.
Detlef
D
Scherer
Cardioangiologisches Centrum Bethanien, Frankfurt/M., Germany.
K R Julian
KRJ
Chun
D000368:Aged; D020517:Atrial Appendage / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004867:Equipment Design; D005260:Female; D005858:Germany; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors
fibrillation; hemorrhage; occlusion; stroke