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Safety and efficacy of left atrial appendage closure in non-valvular atrial fibrillation patients with peripheral arterial disease.

Xian-Xian Zhao

Objective: To investigate the clinical characteristics, safety and efficacy of left atrial appendage closure (LAAC) in non-valvular atrial fibrillation (NVAF) patients with peripheral arterial disease (PAD). Background: LAAC is an alternative therapy to prevent thromboembolism in NVAF patients. The safety and efficacy of LAAC in NVAF patients with PAD remain unclear. Methods: Retrospective analysis was performed in 148 NVAF patients after LAAC who were categorized into two groups: 86 patients with PAD and 62 patients without PAD. Results: The total procedural success rate was 97.3%. There was significant higher thromboembolism risk based on the CHA2DS2-VASc score in patients with PAD (4.7 ± 1.4 vs. 3.0 ± 1.5, p<0.001). The bleeding risk based on the HAS-BLED score was similar between groups (2.6 ± 1.0 vs. 2.3 ± 1.1, p=0.122). There were no significant differences in thromboembolism rate (3.7% vs. 1.7%, p = 0.849), severe bleeding rate (2.5% vs. 1.7%, p=1.000), and mortality (3.5% vs. 0%, p = 0.371) between groups. Estimated annual thromboembolism rate adjusted for warfarin use reduced by 39% in PAD group, while reduced by 50% in non-PAD group after LAAC. Estimated annual severe bleeding rate among those taking warfarin reduced by 54% in PAD group, while reduced by 65% in non-PAD group after LAAC. Conclusion: LAAC was a safe procedure in NVAF patients with PAD. Compared with warfarin, LAAC was associated with a lower risk of thromboembolism as well as severe bleeding in NVAF patients with PAD during follow-up.