Data show LAA closure safe in nonvalvular AF with HF
A database review showed left atrial appendage closure with the Watchman device is safe in adults with HF and atrial fibrillation, who experienced in-hospital mortality and CV complication rates similar to those without HF.
“Left atrial appendage closure has emerged in recent decades as a nonpharmacologic alternative for stroke prevention in nonvalvular AF,” Subrat Das, MD, a resident physician at the Icahn School of Medicine at Mount Sinai, and colleagues wrote in the study background. “Current literature has confirmed the short- and long-term safety of left atrial appendage closure, as well as its efficacy as an alternative to anticoagulation for stroke prevention. However, none of the existing literature provides information specific to the heart failure population.”
Das and colleagues analyzed data from 34,385 left atrial appendage (LAA) closure procedures with a Watchman device (Boston Scientific), including 8,530 done in patients with HF, using the National Inpatient Sample for 2016-2018. The mean age of patients was 76 years, 42% were women and 86% were white. The primary outcome was all-cause inpatient mortality and complications; secondary outcomes were hospital cost and hospital length of stay.
The findings were published in the Journal of Cardiovascular Electrophysiology.
All-cause inpatient mortality was low among patients undergoing the LAA closure procedure, occurring in 54 patients (0.1%). There were no between-group differences in inpatient mortality (adjusted OR = 1.7; 95% CI, 0.5-6.3; P = .42) and cardiac complications (aOR = 1.1; 95% CI, 0.8-1.5; P = .49) among patients with and without HF.
The noncardiac complication rate was higher among patients with HF compared with the non-HF cohort (9.6% vs. 3.8%; aOR = 1.8; 95% CI, 1.4-2.3; P < .001). This was primarily driven by increased incidence of acute kidney injury and respiratory complications in the HF group.
Researchers also observed a difference in mean length of stay between the HF and non-HF groups (mean, 1.8 vs. 1.3 days, respectively) and average hospital cost (mean, $27,185 vs. $25,294; P < .001).
“In spite of finding the heart failure group to be a more comorbid population with higher prevalence of cardiovascular risk factors, there was no difference in in-hospital mortality between both groups,” the researchers wrote. “These results support the safety of Watchman procedure in HF patients. We hope that this safety information will lead to future prospective studies in patients with HF that might elucidate new data about this subgroup of patients.”
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