Interventional Left Atrial Appendage Closure in Atrial Fibrillation: 5-Year Experience from Wellington Hospital

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Background: Left atrial appendage closure (LAAC) has a class IIb indication for stroke prevention in patients with atrial fibrillation (AF) and contraindications to anticoagulation. Method: Patients referred to Wellington Hospital for LAAC were enrolled in a registry since 2014. A moratorium was placed on LAAC in New Zealand in 2014; thus, patients who were shortlisted but did not get a LAAC were used for comparison. Procedural details and outcomes were retrospectively analysed. Primary end points were stroke and all-cause mortality. Secondary end points were myocardial infarction, cardiac failure, venous thromboembolism, and AF admissions. Results: A total of 27 patients were enrolled: 12 underwent LAAC and 15 were treated medically. Both groups had similar baseline demographics. Indications for closure were bleeding (n = 21), ineffective anticoagulation (n = 4), and drug intolerance (n = 2). The mean length of follow-up for LAAC and medical groups was 47.5 and 45 months/patient, respectively. At 1 year, primary end points occurred more frequently in the medically treated group (3 vs 0; hazard ratio [HR], 0.12; 95% CI, 0.02–0.87 [p = 0.034]). By 5 years there was no statistical difference in primary end points between the LAAC and medical group (4 vs 7; HR, 0.75; 95% CI 0.2–2.6 [p = 0.6]). Secondary end points were numerically less common in LAAC, as were strokes, including recurrent strokes (4 vs 12). The median event-free survival was 1563 and 607 days for the LAAC and medical groups, respectively. Conclusion: Our early experience with LAA closure appeared to favour LAAC. At 5 years there were fewer strokes and some favouring parameters in the LAAC group, but, overall, no statistical difference was seen between the two small cohorts.