Left atrial appendage closure in end-stage renal disease and hemodialysis: Data from a German multicenter registry.

Jan 23, 2023

Experts: Thomas Fink,Christina Paitazoglou,Martin W Bergmann,Makoto Sano,Ahmad Keelani,Vanessa Sciacca,Mohammed Saad,Charlotte Eitel,Christian-Hendrik Heeger,Carsten Skurk,Ulf Landmesser,Holger Thiele,Thomas Stiermaier,Georg Fuernau,Jan-Christian Reil,Norbert Frey,Karl-Heinz Kuck,Roland R Tilz,Marcus Sandri,Ingo Eitel

Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). OAC treatment has been proven feasible in mild-to-moderate chronic kidney disease (CKD). In contrast, the optimal antithrombotic management of AF patients with end-stage renal disease (ESRD) is unknown and LAAC has not been proven in these patients in prospective randomized clinical trials.
The objective of this study is to evaluate safety and efficacy of LAAC in patients with ESRD.
Patients undergoing LAAC were collected in a German multicenter real-world observational registry. A composite endpoint consisting of the occurrence of ischemic stroke/transient ischemic attack, systemic embolism, and/or major clinical bleeding was assessed. Patients with ESRD were compared with propensity score-matched patients without severe CKD. ESRD was defined as a glomerular filtration rate < 15 ml/min/1.73 m or chronic hemodialysis treatment.
A total of 604 patients were analyzed, including 57 with ESRD and 57 propensity-matched patients. Overall, 596 endocardial and 8 epicardial LAAC procedures were performed. Frequency of major complications was 7.0% (42/604 patients) in the overall cohort, 8.8% (5/57 patients) in patients with ESRD, and 10.5% (6/57 patients) in matched controls (p = 0.75). The estimated event-free survival of the combined endpoint after 500 days was 90.7 ± 4.5% in patients with ESRD and 90.2 ± 5.5% in matched controls (p = 0.33).
LAAC had comparable procedural safety and clinical efficacy in patients with ESRD and patients without severe CKD.

© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.

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ABOUT THE EXPERTS

Thomas Fink,Christina Paitazoglou,Martin W Bergmann,Makoto Sano,Ahmad Keelani,Vanessa Sciacca,Mohammed Saad,Charlotte Eitel,Christian-Hendrik Heeger,Carsten Skurk,Ulf Landmesser,Holger Thiele,Thomas Stiermaier,Georg Fuernau,Jan-Christian Reil,Norbert Frey,Karl-Heinz Kuck,Roland R Tilz,Marcus Sandri,Ingo Eitel

Thomas Fink

Department of Cardiology, Angiology and Intensive Care Medicine-Division of Electrophysiology, University Heart Center Lübeck, Lübeck, Germany.

Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.

Christina Paitazoglou

Interventional Cardiology, Cardiologicum Hamburg, Hamburg, Germany.

Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Lübeck, Germany.

Martin W Bergmann

Interventional Cardiology, Cardiologicum Hamburg, Hamburg, Germany.

Makoto Sano

Department of Cardiology, Angiology and Intensive Care Medicine-Division of Electrophysiology, University Heart Center Lübeck, Lübeck, Germany.

Ahmad Keelani

Department of Cardiology, Angiology and Intensive Care Medicine-Division of Electrophysiology, University Heart Center Lübeck, Lübeck, Germany.

Vanessa Sciacca

Department of Cardiology, Angiology and Intensive Care Medicine-Division of Electrophysiology, University Heart Center Lübeck, Lübeck, Germany.

Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.

Mohammed Saad

Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Lübeck, Germany.

Department of Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.

German Centre for Cardiovascular Research (DZHK), Partner Site, Hamburg/Kiel/Lübeck, Germany.

Charlotte Eitel

Department of Cardiology, Angiology and Intensive Care Medicine-Division of Electrophysiology, University Heart Center Lübeck, Lübeck, Germany.

German Centre for Cardiovascular Research (DZHK), Partner Site, Hamburg/Kiel/Lübeck, Germany.

Christian-Hendrik Heeger

Department of Cardiology, Angiology and Intensive Care Medicine-Division of Electrophysiology, University Heart Center Lübeck, Lübeck, Germany.

German Centre for Cardiovascular Research (DZHK), Partner Site, Hamburg/Kiel/Lübeck, Germany.

Carsten Skurk

Department of Cardiology, Charité University Medicine, Berlin, Germany.

Ulf Landmesser

Department of Cardiology, Charité University Medicine, Berlin, Germany.

Holger Thiele

Department of Internal Medicine/Cardiology, Heart Center Leipzig, Leipzig, Germany.

Thomas Stiermaier

Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Lübeck, Germany.

German Centre for Cardiovascular Research (DZHK), Partner Site, Hamburg/Kiel/Lübeck, Germany.

Georg Fuernau

Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Lübeck, Germany.

German Centre for Cardiovascular Research (DZHK), Partner Site, Hamburg/Kiel/Lübeck, Germany.

Jan-Christian Reil

Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Lübeck, Germany.

Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.

Norbert Frey

Department of Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.

German Centre for Cardiovascular Research (DZHK), Partner Site, Hamburg/Kiel/Lübeck, Germany.

Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany.

German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Germany.

Karl-Heinz Kuck

Department of Cardiology, Angiology and Intensive Care Medicine-Division of Electrophysiology, University Heart Center Lübeck, Lübeck, Germany.

German Centre for Cardiovascular Research (DZHK), Partner Site, Hamburg/Kiel/Lübeck, Germany.

LANS Medicum, Hamburg, Germany.

Roland R Tilz

Department of Cardiology, Angiology and Intensive Care Medicine-Division of Electrophysiology, University Heart Center Lübeck, Lübeck, Germany.

German Centre for Cardiovascular Research (DZHK), Partner Site, Hamburg/Kiel/Lübeck, Germany.

Marcus Sandri

Department of Internal Medicine/Cardiology, Heart Center Leipzig, Leipzig, Germany.

Ingo Eitel

Department of Cardiology, Angiology and Intensive Care Medicine-Division of Electrophysiology, University Heart Center Lübeck, Lübeck, Germany.

German Centre for Cardiovascular Research (DZHK), Partner Site, Hamburg/Kiel/Lübeck, Germany.