Left atrial appendage occlusion: real world observational data on in-hospital results, clinical outcome and hemoglobin level.

Abstract

Background: Interventional left atrial appendage occlusion (LAAO) was developed as a treatment option for patients who cannot receive traditional anticoagulation therapies. To date, randomized study data on this treatment are still limited, so registries and other non-randomized studies may help define the role of LAAO in clinical practice.

Design: We performed LAAO consecutively on 599 patients. All patients had non-valvular atrial fibrillation and a guideline-based indication for anticoagulation with either a history of a clinically relevant bleeding episode under anticoagulation (post-bleeding patients, PBP) or a high bleeding risk (HBR) based on a joint clinical decision. Data on the patients' index hospital stay were completely recorded; follow-up transesophageal echocardiography (TEE) was performed on approximately 50% of these patients. Clinical and laboratory follow-up data were available for 509 and 458 of these patients, respectively.

Results: Device implantation was successful in 98.8% of cases. There were 7 (1.2%) device dislocations and 6 (1.0%) periprocedural deaths. Of these, 5 deaths were procedure-related, and 4 were due to either accession site bleeding complications or device dislocation. In 96.3% of cases, follow-up TEE showed good results after device implantation. Compared to baseline values, hemoglobin concentration in the PBP group increased significantly by 5.0 g/l during the follow-up interval, while it decreased significantly by 5.0 g/l in the HBR group. During the follow-up period, renal function deteriorated significantly in the total cohort.

Conclusion: LAAO was associated with a significant increase in hemoglobin concentration in patients with a history of clinically relevant bleeding episodes.