Data on the safety and efficacy of left atrial appendage occlusion (LAAO) in elderly patients are limited. We compared clinical outcomes following LAAO between patients ≥80 and <80 years of age. We included patients enrolled in randomized trials and non-randomized registries of the Watchman 2.5 device. The primary efficacy endpoint was a composite of CV/unknown death, stroke, or SE at 5 years. Secondary endpoints included CV/unknown death, stroke, SE, major and non-procedural bleeding. Survival analyses were performed using the Kaplan-Meier, Cox proportional hazards, and competing risk analysis. Interaction terms were used to compare the 2 age groups. We also estimated the average treatment effect of the device using inverse probability weighting. We studied 2,258 patients, of whom 570 (25.2%) were ≥80 year of age, and 1,688 (74.8%) were <80 years of age. Procedural complications at 7 days were similar in both age groups. The primary endpoint occurred in 12.0% vs. 13.8% in the device vs. control group (HR=0.9 [95%CI 0.6-1.4]) among patients <80 years of age and in 25.3% vs. 21.7% in the device vs. control group (HR=1.2 [95%CI 0.7-2.0]) among patients ≥80 (interaction p-value=0.48). There was no interaction between age and treatment effect for any of the secondary outcomes. The average treatment effects of LAAO (as compared with Warfarin) were similar in the elderly population (as compared with younger patients). Despite the higher event rates, octogenarians derive similar benefits from LAAO as their younger counterparts. Age alone should not preclude LAAO in otherwise suitable candidates.

Editor-in-Chief

Kalyanam Shivkumar, MD, PhD, FACC 

CME Editor
Kenneth A. Ellenbogen, MD, FACC

Author
Mahmoud Houmsse, MD, FACC

Important Dates
Date of Release: May 22, 2023
Term of Approval/Date of CME/MOC Expiration: May 21, 2024