Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation and Hemodialysis: An International, Multicentric Registry

Background: The net benefit of oral anticoagulation in patients with end-stage renal disease on hemodialysis (HD) is uncertain. In recent years, left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation; however, there is scant evidence of LAAC in patients on HD. Objectives: This study aimed to assess the feasibility and safety of LAAC in patients on HD. Methods: In an international multicenter registry, patients’ baseline characteristics and procedural and follow-up data were recorded from all patients on HD with atrial fibrillation who underwent LAAC. Results: A total of 147 patients from 9 centers were included. The mean age was 72.6 ± 10.4 years; the mean CHA2DS2-VASc-score was 4.6 ± 1.5, and the mean HAS-BLED-score was 4.7 ± 1.1. Antithrombotic treatment regimens prior to implantation were notably diverse, encompassing more than 12 distinct combinations. Technical successful LAA at first procedure was achieved in 144 of 147 (98%) patients and major complications were observed in 4.7% (7 of 149 procedures). The median follow-up was 427 days (Q1-Q3: 184-797 days), no device-related thrombi were detected, and peridevice leaks ≥5 mm were 1.7% at first imaging control. The most common post-implantation antithrombotic therapy was single antiplatelet therapy with 165.9 patient-years (py). During follow-up of 222.9 py, the annual stroke rate was 0.9%, reflecting an 88% relative risk reduction (P < 0.001) compared to historical data. Similarly, the annual rate of major bleeding was 4.5%, signifying a 55% relative risk reduction (P = 0.023). Throughout follow-up, 29 deaths (19.9%) were recorded. Conclusions: LAAC in end-stage renal disease patients on HD demonstrated an acceptable safety profile, coupled with a notably low incidence of strokes. This was paralleled by low bleeding rates.