Abstract: 

Background: The clinical performance of left atrial appendage occlusion (LAAO) as a procedure and the long-term impact of its varied implantation configurations and anticoagulation regimens remain unclear.

Objectives: To provide data in routine practice from a prospective multicenter registry.

Methods: A total of 3,096 consecutive patients from 39 Chinese centers undergoing LAAO were enrolled between April 1, 2019, and October 31, 2020.

Results: The baseline CHA₂DS₂-VASc and HAS-BLED scores were 4.0±1.8 and 2.4±1.2, respectively; mean age was 69±9 years. One-year follow-up was completed in 3013 (97.8%) patients. The ischemic endpoint of death, stroke, and systemic embolism occurred in 133 (4.51%) patients, while life-threatening, disabling, or major bleeding occurred in 71 (2.36%) patients. After inverse probability of treatment weighting, no significant association was found between anesthesia type (moderate sedation versus general anesthesia) or image guidance (transesophageal/intracardiac echocardiography versus fluoroscopy) and ischemic or bleeding events. In 1295 (42.0%) cases, LAAO combined with catheter ablation was associated with a significantly lower rate of death, stroke, or systemic embolism than LAAO only (3.5% versus 5.2%, HR_IPTW:0.68, 95%CI:0.47-0.99). The most common post-LAAO antithrombotic regimen was warfarin/NOAC monotherapy for 45 days, followed by single/dual antiplatelet therapy (38.1%).

Conclusions: In Chinese centers, patients undergoing LAAO had low rates of ischemic and bleeding events at one year. Combining LAAO with catheter ablation was associated with a lower rate of ischemic events than LAAO only.

JACC: Asia Editor-in-Chief 

Jian’an Wang, MD, PhD, FACC

CME Editor 

Kenneth A. Ellenbogen, MD

Author
Sabeeda Kadavath, MD

Important Dates

Date of Release: October 1, 2024
Term of Approval/Date of CME/MOC Expiration: September 30, 2025