PO-701-04 OUTCOMES OF LEFT ATRIAL APPENDAGE CLOSURE IN PATIENTS WITH ATRIAL FIBRILLATION AND END-STAGE RENAL DISEASE ON DIALYSIS

Abstract

Oral anticoagulation (OAC) therapy is the mainstay of treatment for stroke-risk reduction in patients with atrial fibrillation (AF). However, OAC use in patients with end-stage renal disease (ESRD) on dialysis is associated with a significantly increased risk of bleeding and an uncertain benefit in stroke reduction. In these patients, left atrial appendage closure (LAAC) could be alternative. To describe procedural efficacy, safety, and clinical outcomes of patients with AF and ESRD on dialysis undergoing LAAC for stroke prevention. Consecutive patients with AF and ESRD who underwent LAAC for stroke prevention were included. LAAC was performed with Watchman (Boston Scientific) under continuous echocardiographic guidance. Baseline clinical and procedural characteristics, post procedural anticoagulation and clinical outcomes during follow-up were collected. The primary endpoint was the risk of stroke, which was compared to historical cohorts. The secondary endpoints were procedure related complications and all-cause mortality. Between October 2017 and October 2021, a total of 27 patients (mean age 70 years, +/- 9.1; 29.6% female, mean CHA2DS2Vasc score 4.6, +/-2.1) were included. Sixteen patients (59%) had prior history of bleeding on OAC. Procedural success was achieved in 26 (96%) patients. Postprocedural treatment included time limited OAC (48%), single or dual antiplatelet therapy (22% and 26% respectively), or no antithrombotic treatment (3%). No stroke or embolic events were reported at a mean follow up of 482 days. Compared with a historical cohort that reported a risk of hospitalization for stroke of 7.7% with OAC, a significant reduction in the risk of stroke was observed. Two patients had procedure related complications. Six patients died (22%), none of them due to stroke or procedure related complications. Mortality was lower than 41% reported in a similar cohort on OAC. Patients with ESRD and AF undergoing LAAC have a significant reduction in the risk of stroke during follow-up. Although all-cause mortality is high in this group of patients, LAAC should be considered in this group of patients as a treatment option taking into consideration the lack of proven net clinical benefit with OAC therapy and the favorable reduction in stroke risk.