Impact of Immunosuppressive Drugs on Patients With Percutaneous Left Atrial Appendage Occlusion.

Abstract

Introduction: Percutaneous left atrial appendage closure (LAAC) reduces the risk of thromboembolic stroke in patients with non-valvular atrial fibrillation who cannot tolerate long-term oral anticoagulation. However, outcomes after LAAC in patients requiring chronic immunosuppressive therapy (IMS) remain unknown. This study aimed to investigate the perioperative and long-term outcomes of percutaneous LAAC in patients receiving chronic IMS.

Methods and results: Patients who underwent LAAC were retrospectively evaluated according to the presence of long-term IMS therapy. Perioperative complications, clinical outcomes, and device follow-up characteristics were evaluated. From November 2017 to March 2023, a total of 1172 patients who underwent LAAC were included (69.3% male, 74.8 years), of whom 74 were taking IMS. The most common reasons for IMS use were rheumatoid arthritis (50.0%), followed by kidney transplantation (17.6%). There were no significant differences in intraoperative complications between the IMS group and the non-IMS group. (1.4% vs. 1.3%, p = 0.943). During 617 [IQR: 373-1046] days, the incidence of systemic infections was higher in the IMS group (25.0% vs. 6.1%, p < 0.001). There were no significant differences in peri-device leak (PDL) or device-related thrombus, but the IMS group had a lower percentage of patients with improvement of PDL during follow-up (8.3% vs. 50.0%, p = 0.003).

Conclusion: Successful LAAC in patients on IMS was achieved without increasing perioperative complications. Patients on chronic IMS did have an increased occurrence of systemic infections during long-term follow-up. The presence of IMS use was negatively associated with PDL improvement during follow-up.