Procedural and long-term thromboembolic outcomes after left atrial appendage closure: comparison of patients with reduced and preserved left ventricular ejection fraction.

Abstract

Objectives: To evaluate the impact of left ventricular ejection fraction (LVEF) on periprocedural complications and long-term thromboembolic events in patients with non-valvular atrial fibrillation (NVAF) treated with interventional left atrial appendage closure (LAAC).

Methods: In a retrospective single-center study, a total of 612 patients who underwent successful interventional LAAC were divided into 2 groups: 139 patients with reduced LVEF (less than 50%) and 473 patients with preserved LVEF (≥ 50%). Baseline characteristics, in-hospital procedural complications, and long-term thromboembolic events were compared between the 2 groups.

Results: Patients with reduced LVEF were more likely to be female with a higher CHA2DS2-VA-Score (median 5 vs 4; P less than .0001) and had higher rates of diabetes mellitus (54% vs. 40%; P = .003) and coronary/peripheral artery disease (68% vs 41%; P less than .0001). There was no significant difference in procedure-related complications (major or minor bleeding [2.1% vs 4.2%; P = .44], access site complications [0% vs 4.2%; P = .08], cardiac tamponade [0.7% vs. 0.6%; P = .91], transient ischemic attack (TIA) [1.4% vs. 0.4%; P = .19], stroke [0% vs 0%], and in-hospital death [0% vs 0%]) between the 2 groups. Both groups had a similar median duration of long-term follow-up (20 vs 19 months, respectively; P = .15). During follow-up, there was no significant difference in the rates of TIA (2.2% vs 1.1%; P = .32), stroke (0.7% vs 1.9%; P = .33), or systemic thromboembolic events (0.7% vs 0.4%; P = .66) between the 2 groups.

Conclusions: In patients with reduced LVEF, the procedural safety of LAAC and the long-term rate of thromboembolic events were consistently low and comparable to patients with preserved LVEF.