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Indications for and outcome in patients undergoing left atrial appendage closure - Results of the Austrian LAAC Registry

Introduction: According to recent ECS guidelines LAAC is an established treatment option for patients with atrial fibrillation and either contraindication to (N)OAC, increased bleeding risk, ischemic stroke despite anticoagulation or non-compliance with anticoagulation (IIa B indication). The goal of the Austrian registry was to describe and assess indications, post-procedural management strategies, short- and long-term outcomes during the first five years of the LAAC program.

Methods and Results: The registry included all patients (n=157) undergoing LAAC procedures in Austria between 2012 and 2017 (age 74±7 years, 38% female; median CHA2DS2-VASc score of 4, median HAS-BLED score 3). As for the indication, 80 (51%) had a major bleeding under OAC (32% intracranial, 24% GI bleeding, 3% other), 27 (17%) had a thromboembolic event despite of OAC and 39 (25%) had other indications, such as anaemia (10%), requirement for triple therapy (5%), predisposition for bleeding (3%), or other (8%).

Amplatzer (SJM, St. Paul, MN, US) occluders were used in 84 patients (54%) and Watchman (Boston Scientific, Malborough, MA, US) occluders in 72 patients (46%). A median size of 25 mm (IQR 22-27 mm) was used. Median duration of procedure was 65 (IQR 54-90) minutes. Procedural success was 97%. Major procedural complication rate was 9%, including anaemia requiring transfusion (3%), femoral pseudoaneurysma requiring intervention (3%) or hemodynamically relevant pericardial effusion (2%). Median hospitalisation duration was 3 (IQR 2-5) days. Postprocedurally, most patients received dual antiplatelet therapy (54%) for 1.5 to 6 months and aspirin (40%), no antithrombotic therapy (40%), OAC (7%) or clopidogrel (4%) thereafter.

During follow up of 230±25 days, 10% of patients experienced major long-term complications (6% bleeding, 3% stroke, 1% hospitalisation due to displacement of LAA occluder).

Discussion: In daily clinical practice in Austria, LAAC proved to be feasible. Short and long-term complication rates were comparable to other studies.