eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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1/2022
vol. 18
 
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abstract:
Original paper

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

Wirginia Michlicka-Kłyś
1
,
Zbigniew Kalarus
1
,
Tomasz Podolecki
1
,
Katarzyna Mitręga
1
,
Witold Streb
1

  1. Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
Adv Interv Cardiol 2022; 18, 1 (67): 43–49
DOI: https://doi.org/10.5114/aic.2022.115319
Online publish date: 2022/04/11
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Introduction
The 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.

Aim
To evaluate the long-term outcomes of LAAO performed in patients with CKD and non-valvular AF.

Material and methods
Two 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.

Results
The 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.

Conclusions
Considering 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.

keywords:

atrial fibrillation, chronic kidney disease, left atrial appendage occlusion, stroke
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