Long-term results of percutaneous left atrial appendage occlusion in patients with atrial fibrillation and chronic kidney disease.

Abstract

IntroductionThe coexistence of atrial fibrillation (AF) and chronic kidney disease (CKD) increases the risk of thromboembolic complications, as well as hemorrhagic incidents – percutaneous left atrial appendage occlusion (LAAO) is an alternative.AimTo evaluate the long-term outcomes of LAAO performed in patients with CKD and non-valvular AF.Material and methodsTwo hundred and seventy-two patients with AF who underwent LAAO between 2009 and 2019 were prospectively analyzed. Patients were divided into two groups: CKD (105 patients) and non-CKD (167 patients) (cut-off point: eGFR 60 ml/min/1.73 m2). The mean follow-up period was 25.56 months.ResultsThe LAAO was successful in 269 (98.9%) patients. Seven (2.6%) patients suffered an ischemic stroke, including 2 (1.9%) with CKD and 5 (3.0%) in the non-CKD (p = 0.581) group. The risk of ischemic stroke was 0.25/100 patient-years (PY) for CKD and 0.39/100 PY for the non-CKD (p =0.028) group. The LAAO was associated with a relative risk reduction (RRR) of 96.4% (CKD group) and 91.8% (non-CKD group) on average compared to expected stroke rates. Hemorrhagic stroke occurred in 1 (0.6%) patient of the non-CKD group, whereas major bleeding occurred in 1 (0.6%) non-CKD patient and 1 (1.0%) CKD patient (p = 0.427). The risk of major bleeding was 0.13/100 PY for CKD and 0.15/100 PY for non-CKD (p = 0.768), corresponding to an RRR of 97.9% (CKD) and 97.4% (non-CKD) on average compared to oral anticoagulant therapy.ConclusionsConsidering the significant reduction in thromboembolic events, with a simultaneous reduction of major bleeding complications, LAAO is a safe and effective alternative for AF patients with CKD.