Safety And Long-term Stroke Prevention After Left Atrial Appendage Closure In Elderly Patients With Atrial Fibrillation

Objective:To evaluate the perioperative safety and long-term safety and efficacy of stroke prevention after percutaneous left atrial appendage closure in elderly patients aged >75 years with non-valvular atrial fibrillation.Methods: A total of 88 patients with symptomatic non-valvular atrial fibrillation who were successfully treated with left atrial appendage closure at the Department of Cardiology,Anhui Provincial Hospital Affiliated to Anhui Medical University,from June 2017 to June 2021 were retrospectively included,and they were divided into senior and non-senior groups according to their age >75 and ≤ 75 years,and the clinical baseline data,intraoperative parameters,perioperative complications,and device related thrombosis correlation during long-term follow-up were analyzed in both groups.The incidence of clinical adverse events such as thrombosis,peri-device residual shunt,ischemic stroke,and major bleeding were retrospectively analyzed in both groups.Results: A total of 88 patients,aged(67.6±8.7)years,50 male patients and 38 female patients were included in this study.There were 30 cases of paroxysmal AF and 58 cases of persistent AF.The type of AF,previous history of heart failure,hypertension,diabetes mellitus and previous history of radiofrequency ablation of AF,ischemic stroke/TIA and systemic embolism in the senior and non-senior groups were not statistically significant(all P > 0.05).The CHA2DS2-VASc score increased in the senior group compared to the non-senior group,being(4.9±1.5)versus(3.6±1.6)(P=0.003).The differences in intraoperative parameters between the two groups were not statistically significant;The incidence of perioperative-related pericardial effusion(0versus 2.9%,P=1.000),cardiac tamponade(0 versus 2.9%,P=1.000),other bleeding events(0 versus 2.9%,P=1.000),vascular puncture complications(11.1% versus 2.9%,P=0.134)and incidence of peptic ulceration/obstruction(5.6% versus 0.P=0.205)were not statistically significant,and no serious complications such as procedure-related death,ischemic stroke/TIA and hemorrhage,or acute heart failure occurred in the perioperative period in either group.At follow-up(31.8±13.7)months,there were no statistically significant differences between the two groups in terms of cardiovascular death(5.6% vs.0,P=0.205),residual shunt around the device(22.2% vs.10.0%,P=0.162)and incidence of device-related thrombosis(5.6% vs.2.9%,P=0.574),and ischemic stroke and major bleeding events in patients in the senior group were 5.0/100person-years and 2.5/100 person-years,respectively.The rates of ischemic stroke and major bleeding events were 5.0/100 person-years and 2.5/100 person-years,respectively,in the advanced age group and 4.1/100 person-years and 0.5/100 person-years,respectively,in the non-advanced age group.The relative risk of major bleeding events decreased more in the non-senior group(90.0% versus 56.9%).Conclusion: In non-valvular elderly patients with atrial fibrillation at high risk for stroke events,left atrial appendage closure has a good perioperative safety profile and is safe and effective in preventing ischemic stroke and/or transient ischemic attack at long-term follow-up.