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Open Access 01-05-2022 | Stroke | Original Paper

Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

Authors: Shinwan Kany, Johannes Brachmann, Thorsten Lewalter, Ibrahim Akin, Horst Sievert, Uwe Zeymer, Jakob Ledwoch, Hüseyin Ince, Dierk Thomas, Matthias Hochadel, Jochen Senges, Paulus Kirchhof, Andreas Rillig

Published in: Clinical Research in Cardiology | Issue 5/2022

Abstract

Background

Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death.

Methods

Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE).

Results

A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA₂DS₂-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA₂DS₂-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p = 0.041).

Conclusion

Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality.

Graphic abstract

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Title: Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry
Authors: Shinwan Kany
Johannes Brachmann
Thorsten Lewalter
Ibrahim Akin
Horst Sievert
Uwe Zeymer
Jakob Ledwoch
Hüseyin Ince
Dierk Thomas
Matthias Hochadel
Jochen Senges
Paulus Kirchhof
Andreas Rillig
Publication date: 01-05-2022
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Atrial Fibrillation
Published in: Clinical Research in Cardiology / Issue 5/2022
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-021-01874-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

Abstract

Background

Methods

Results

Conclusion

Graphic abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Graphic abstract

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