Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

• Published in: Clinical research in cardiology 2022-05, Vol.111 (5), p.511-521
• Main Authors: Kany, Shinwan, Brachmann, Johannes, Lewalter, Thorsten, Akin, Ibrahim, Sievert, Horst, Zeymer, Uwe, Ledwoch, Jakob, Ince, Hüseyin, Thomas, Dierk, Hochadel, Matthias, Senges, Jochen, Kirchhof, Paulus, Rillig, Andreas
• Format: Article
• Language: English
• Subjects: Atrial Appendage - diagnostic imaging; Atrial Appendage - surgery; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Cardiac arrhythmia; Cardiology; Complications; Death; Embolism; Embolism - complications; Embolism - etiology; Embolisms; Fibrillation; Hemorrhage; Humans; Medicine; Medicine & Public Health; Mortality; Original Paper; Patients; Platelet-activating factor; Prospective Studies; Registries; Stroke - epidemiology; Stroke - etiology; Stroke - prevention & control; Treatment Outcome
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-021-01874-3

Background Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. Methods Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). Results A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p  = 0.066). The total CHA 2 DS 2 -VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p  = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p  = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p  = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p  = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p  = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort ( p  = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p  = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p  = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA 2 DS 2 -VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p  = 0.041). Conclusion Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality. Graphic abstract