Association of advanced age with procedural complications and in-hospital outcomes from left atrial appendage occlusion device implantation in patients with atrial fibrillation: insights from the National Inpatient Sample of 36,065 procedures.

Age-stratified analyses of atrial fibrillation (AF) patients undergoing percutaneous left atrial appendage occlusion (LAAO) are limited. The purpose of current study was to compare in-hospital outcomes in elderly AF patients (age > 80 years) to a relatively younger cohort (age £ 80 years) after LAAO. Data were extracted from National Inpatient Sample for calendar years 2015-2018. LAAO device implantations were identified on the basis of International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes of 37.90 and 02L73DK. The outcomes assessed in our study included complications, inpatient mortality, and resource utilization with LAAO. A total of 36,065 LAAO recipients were included in the final analysis, of which 34.6% (n=12,475) were performed on elderly AF patients. Elderly AF patients had a higher prevalence of major complications (6.7% vs. 5.7%, p < 0.01) and mortality (0.4% vs. 0.1%, p < 0.01) after LAAO device implantation in the crude analysis. After multivariate adjustment of potential confounders, age > 80 years was associated with increased risk of inpatient mortality (adjusted odds ratio [aOR] 4.439, 95% confidence interval [CI] 2.391-8.239) but not major complications (aOR 1.084, 95% CI 0.971-1.211), prolonged length of stay (aOR 0.943, 95% CI 0.88-1.101), or increased hospitalization costs (aOR 0.909, 95% CI 0.865-0.955). Over 1 in 3 LAAO device implantations occurred in elderly AF patients. After adjusting for potential confounding variables, advanced age was associated with inpatient mortality, but not with other LAAO procedural-related outcomes including major complications, prolonged length of stay, or increased hospitalization costs.

Munir MB ，Khan MZ ，Darden D ，Asad ZUA ，Choubdar PA ，Din MTU ，Osman M ，Singh GD ，Srivatsa UN ，Balla S ，Reeves R ，Hsu JC ... -  《-》

Patient Characteristics Associated With Using Transcatheter Left Atrial Appendage Occlusion Versus Oral Anticoagulants for Atrial Fibrillation.

Lin KJ ，Singer DE ，Avorn J ，Heist EK ，Sreedhara SK ，Anand P ，Zhang Y ，Tsacogianis TN ，Schneeweiss S ... -  《-》

Strategy Optimization for a Combined Procedure in Patients With Atrial Fibrillation: The COMBINATION Randomized Clinical Trial.

Du X ，Chu H ，Yang B ，Zhong J ，Ruan Z ，Chen Q ，Leng B ，Tao S ，Lai H ，Liang J ，Xie R ，Ye P ，Zhou X ，Li Y ，Li J ，Zhao Y ，Zou C ，Sun H ，Li X ，Rong B ，Chen G ，Hu J ，Jia J ，Fang Y ，Xia Z ，Liu Q ，Zuo T ，Zhu X ，Xu L ，Yang S ，Luo C ，Shen C ，Feng M ，Jiang Y ，Fu G ，Wang B ，Yu X ，Chen X ，COMBINATION Trial Investigators ... -  《JAMA Network Open》

Lower rate of major bleeding in very high risk patients undergoing left atrial appendage occlusion: A propensity score-matched comparison with direct oral anticoagulant.

Long-term oral anticoagulation is the mainstay therapy for thromboembolic (TE) prevention in patients with atrial fibrillation. However, left atrial appendage occlusion (LAAO) could be a safe alternative to direct oral anticoagulants (DOACs) in patients with a very high TE risk profile. The purpose of this study was to compare the safety and efficacy of LAAO vs DOACs in patients with atrial fibrillation at very high stroke risk (CHA2DS2-VASc [congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category] score ≥ 5). Data from patients with CHA2DS2-VASc score ≥ 5 were extracted from a prospective multicenter database. To attenuate the imbalance in covariates between groups, propensity score matching was used (covariates: CHA2DS2-VASc and HAS-BLED [hypertension, abnormal renal or liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol] scores), which resulted in a matched population of 277 patients per group. The primary end point was a composite of cardiovascular death, TE events, and clinically relevant bleeding during follow-up. Of 2381 patients, 554 very high risk patients were included in the study (mean age 79 ± 7 years; CHA2DS2-VASc score 5.8 ± 0.9; HAS-BLED score 3.0 ± 0.9). The mean follow-up duration was 25 ± 11 months. A higher incidence of the composite end point was documented with DOACs compared with LAAO (14.9 events per 100 patient-years in the DOAC group vs 9.4 events per 100 patient-years in the LAAO group; P = .03). The annualized clinically relevant bleeding risk was higher with DOACs (6.3% vs 3.2%; P = .04), while the risk of TE events was not different between groups (4.1% vs 3.2%; P = .63). In high-risk patients, LAAO had a similar stroke prevention efficacy but a significantly lower risk of clinically relevant bleeding when compared with DOACs. The clinical benefit of LAAO became significant after 18 months of follow-up.

Magnocavallo M ，Della Rocca DG ，Vetta G ，Mohanty S ，Gianni C ，Polselli M ，Rossi P ，Parlavecchio A ，Fazia MV ，Guarracini F ，De Vuono F ，Bisignani A ，Pannone L ，Raposeiras-Roubín S ，Lochy S ，Cauti FM ，Burkhardt JD ，Boveda S ，Sarkozy A ，Sorgente A ，Bianchi S ，Chierchia GB ，de Asmundis C ，Al-Ahmad A ，Di Biase L ，Horton RP ，Natale A ... -  《-》

Efficacy of surgical ablation and left atrial appendage occlusion in patients with AF undergoing coronary artery bypass grafting: A network meta-analysis.

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia that greatly elevates the risk of stroke. This risk increases both during and after cardiac procedures, such as coronary artery bypass grafting (CABG). There is an increasing interest in non-pharmacological treatments such as left atrial appendage occlusion (LAAO) and surgical ablation, intending to enhance both immediate and long-term postoperative results. To investigate the efficacy of surgical ablation (SA), LAAO, or both in patients with AF undergoing CABG. We searched four electronic databases: PubMed, Scopus, Cochrane Library, and WOS. We analyzed data using R language and "netmeta" and "netrank" packages of meta-insight software. Pooled outcomes were reported as mean difference or risk ratio (RR) with 95 % confidence interval (CI) in a random effect method. A total of 16 studies were included with 594,312 patients included. The 30-day mortality showed a non-statistically significant difference between CABG-LAAO compared to CABG alone and CABG-SA with RR of 1.70 (95%CI 0.38-7.61) and 0.62 (95%CI 0.10-3.94). However, compared to CABG alone, CABG-SA + LAAO, CABG-LAAO, and CABG-SA had significantly lower risk of long-term mortality with RR 0.75 (95%CI 0.57-0.98), 0.78 (95%CI 0.65-0.94), and 0.73 (95%CI 0.61-0.88), respectively. CABG-SA + LAAO, CABG-LAAO, and CABG-SA reduced the risk of short-term stroke compared to CABG alone with RR of 0.73 (95%CI 0.43-1.24), 0.93 (95%CI 0.78-1.11), and 1.01 (95%CI 0.75-1.36), respectively. Moreover, only CABG-SA + LAAO and CABG-LAAO showed a statistically significant reduction in long term stroke and hospitalization due to heart failure while CABG-SA showed no statistically significant difference. Furthermore, there was no statistically significant difference between our interventions in terms of 30-day rehospitalization, intra-aortic balloon pump support, and risk of hemorrhage. Among patients with AF undergoing CABG, whether undergoing SA alone or LAAO alone or both showed significant clinical outcomes such as reduced risk of both short- and long-term mortality and short-term stroke.

Awad AK ，Elbahloul MA ，Gamal A ，Attia AN ，Hamed SM ，Elsekhary AI ，Sá MP ... -  《-》