Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation and Hemodialysis An International, Multicentric Registry

被引：0

作者：

Urbanek, Lukas ^{[1
]}

Heine, Gunnar H. ^{[2
,3
]}

Reddavid, Claudia ^{[4
]}

Saw, Jacqueline ^{[4
]}

Kawamura, Iwanari ^{[5
]}

Reddy, Vivek Y. ^{[5
]}

Galea, Roberto ^{[6
]}

Raeber, Lorenz ^{[6
]}

Sedaghat, Alexander ^{[7
]}

Della Rocca, Domenico G. ^{[8
,9
]}

Natale, Andrea ^{[8
,10
]}

Fassini, Gaetano ^{[11
]}

Tondo, Claudio ^{[11
]}

Doshi, Shephal K. ^{[12
]}

Peng, Dorothy S. ^{[12
]}

von Bardeleben, Ralph Stephan ^{[13
]}

Kreidel, Felix ^{[14
]}

Schmidt, Boris ^{[1
]}

机构：

[1] Agaples Markus Krankenhaus, Cardioangiol Ctr Bethanien, Frankfurt, Germany

[2] Saarland Univ, Med Ctr, Internal Med Nephrol & Hypertens 4, Homburg, Germany

[3] Agaples Markus Krankenhaus, Frankfurt, Germany

[4] Vancouver Gen Hosp, Div Cardiol, Vancouver, BC, Canada

[5] Icahn Sch Med Mt Sinai, Dept Cardiol, Helmsley Electrophysiol Ctr, New York, NY USA

[6] Univ Bern, Bern Univ Hosp, Dept Cardiol, Bern, Switzerland

[7] Univ Klinikum Bonn, Herzzentrum, Med Klin & Poliklin 2, Bonn, Germany

[8] St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, Austin, TX USA

[9] Vrije Univ Brussel, Universitair Ziekenhuis Brussel, European Reference Networks Guard Heart, Heart Rhythm Management Ctr,Postgrad Program Cardi, Brussels, Belgium

[10] Ctr Cardiol Monzino, Milan, Italy

[11] Pacific Heart Inst, Santa Monica, CA USA

[12] Pacific Heart Inst, Santa Monica, CA USA

[13] Unimed Mainz, Heart & Vasc Ctr, Dept Cardiol, Mainz, Germany

[14] Univ Klinikum Schleswig Holstein, Dept Cardiol, Campus Kiel, Kiel, Germany

来源：

JACC-CLINICAL ELECTROPHYSIOLOGY | 2025年 / 11卷 / 01期

关键词：

anticoagulation; atrial brillation; hemodialysis; left atrial appendage closure; stroke; CHRONIC KIDNEY-DISEASE; PERI-PROCEDURAL OUTCOMES; ORAL ANTICOAGULATION; WATCHMAN DEVICE; IMPLANT SUCCESS; BLEEDING RISK; FOLLOW-UP; STROKE; CLOSURE; WARFARIN;

D O I：

10.1016/j.jacep.2024.09.038

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The net benefit of oral anticoagulation in patients with end-stage renal disease on hemodialysis (HD) is uncertain. In recent years, left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation; however, there is scant evidence of LAAC in patients on HD. OBJECTIVES This study aimed to assess the feasibility and safety of LAAC in patients on HD. METHODS In an international multicenter registry, patients' baseline characteristics and procedural and follow-up data were recorded from all patients on HD with atrial fibrillation who underwent LAAC. RESULTS A total of 147 patients from 9 centers were included. The mean age was 72.6 f 10.4 years; the mean CHA2DS2-VASc-score was 4.6 f 1.5, and the mean HAS-BLED-score was 4.7 f 1.1. Antithrombotic treatment regimens prior to implantation were notably diverse, encompassing more than 12 distinct combinations. Technical successful LAA at first procedure was achieved in 144 of 147 (98%) patients and major complications were observed in 4.7% (7 of 149 procedures). The median follow-up was 427 days (Q1-Q3: 184-797 days), no device-related thrombi were detected, and peridevice leaks >= 5 mm were 1.7% at first imaging control. The most common post-implantation antithrombotic therapy was single antiplatelet therapy with 165.9 patient-years (py). During follow-up of 222.9 py, the annual stroke rate was 0.9%, reflecting an 88% relative risk reduction (P < 0.001) compared to historical data. Similarly, the annual rate of major bleeding was 4.5%, signifying a 55% relative risk reduction (P = 0.023). Throughout follow-up, 29 deaths (19.9%) were recorded. CONCLUSIONS LAAC in end-stage renal disease patients on HD demonstrated an acceptable safety profile, coupled with a notably low incidence of strokes. This was paralleled by low bleeding rates.(c) 2025 by the American College of Cardiology Foundation.

引用

页码：71 / 82

页数：12

共 44 条

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