Left atrial appendage closure in patients with a reduced left ventricular ejection fraction: results from the multicenter German LAARGE registry
Authors:
Christian Fastner, Johannes Brachmann, Thorsten Lewalter, Uwe Zeymer, Horst Sievert, Martin Borggrefe, Christian Weiß, Volker Geist, Alexander Krapivsky, Matthias Käunicke, Harald Mudra, Matthias Hochadel, Steffen Schneider, Jochen Senges, Ibrahim Akin
Interventional left atrial appendage closure (LAAC) effectively prevents thromboembolic events in atrial fibrillation patients. Impaired left ventricular ejection fraction (LVEF) increases not only the thromboembolic risk but also the complication rates of cardiac interventions. The LAAC procedure’s benefit in patients with an impaired LVEF, therefore, has yet to be investigated.
Methods
LAARGE is a prospective, non-randomized registry depicting the clinical reality of LAAC in Germany. Procedure was conducted with different standard commercial devices, and follow-up period was one year. In the sense of an as-treated analysis, patients with started procedure and documented LVEF were selected from the whole database.
Results
619 patients from 37 centers were categorized into one of three groups: LVEF > 55% (56%), 36–55% (36%), and ≤ 35% (8%). Prevalence of cardiovascular comorbidity increased with LVEF reduction (p < 0.001 for trend). CHA2DS2-VASc score was 4.3, 4.8, and 5.1 (p < 0.001), and HAS-BLED score was 3.7, 4.1, and 4.2 (p < 0.001). Implantation success was consistently high (97.9%), rates of intra-hospital MACCE (0.5%), and other major complications (4.2%) were low (each p = NS). Kaplan–Meier estimation showed a decrease in survival free of stroke with LVEF reduction during one-year follow-up (89.3 vs. 87.0 vs. 79.8%; p = 0.067), a trend which was no longer evident after adjustment for relevant confounding factors. Rates of non-fatal strokes (0.4 vs. 1.1 vs. 0%) and severe bleedings (0.7 vs. 0.0 vs. 3.1%) were consistently low across all groups (each p = NS).
Conclusions
LVEF reduction neither influenced the procedural success nor the effectiveness and safety of stroke prevention by LAAC.
Left atrial appendage closure in patients with a reduced left ventricular ejection fraction: results from the multicenter German LAARGE registry
Authors
Christian Fastner Johannes Brachmann Thorsten Lewalter Uwe Zeymer Horst Sievert Martin Borggrefe Christian Weiß Volker Geist Alexander Krapivsky Matthias Käunicke Harald Mudra Matthias Hochadel Steffen Schneider Jochen Senges Ibrahim Akin