Causes of death and morbidity in patients with atrial fibrillation after left atrial appendage occlusion

BACKGROUND Left atrial appendage occlusion (LAAO) is a safe and effective alternative for stroke prevention in patients with atrial fibrillation (AF). However, there is little literature on the exact causes of death and adverse events during follow-up after LAAO. AIMS The primary aim of this study was to evaluate survival free of any serious adverse events and of any-cause death in midterm follow-up. The secondary aims were to analyze causes of mortality and further hospitalization as well as adverse events, thromboembolism, and bleeding risk reduction during follow-up. METHODS A retrospective, single-center study was performed in 84 consecutive patients with AF who underwent LAAO with endocardial occluders. The mean (SD) CHADS(2) score was 3.5 (1.1), CHA(2)DS(2)-VASc score, 5.0 (1.5), and HAS-BLED score, 4.4 (0.9). After LAAO, dual 6-month antiplatelet therapy and then lifelong aspirin monotherapy was recommended. Mean (SD) follow-up was 25.3 (13.2) months with an accumulated total follow-up of 174.6 patient-years. RESULTS The annual mortality rate was 12.02%. More than half of deaths (57%) were due to noncardiovascular causes with leading malignancy. Survival at the end of the periprocedural period was 98.8%, at 3 months, 97.6%, at 6 months, 95.2%, at 12 months, 86.5%, at 18 months, 85.1%, and at 24 months, 80.6%. The average annual thromboembolic event rate was 2.87%. The most common adverse event was severe bleeding with an annual rate of 6.3% (3 cases while receiving dual antiplatelet therapy and 6 cases while receiving aspirin). CONCLUSIONS The majority of deaths were not related to stroke in patients with AF after LAAO. Mortality in first 2 years following the procedure was predominantly from noncardiovascular causes.