Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2021 Jan;110(1):12-20.
doi: 10.1007/s00392-020-01638-5. Epub 2020 Apr 15.

Left atrial appendage closure in patients with chronic kidney disease: results from the German multicentre LAARGE registry

Christian Fastner  1 , Johannes Brachmann  2 , Thorsten Lewalter  3 , Uwe Zeymer  4 , Horst Sievert  5   6 , Martin Borggrefe  1 , Christoph A Nienaber  7 , Christian Weiß  8 , Sven T Pleger  9 , Hüseyin Ince  10   11 , Jens Maier  12 , Stephan Achenbach  13 , Holger H Sigusch  14 , Matthias Hochadel  15 , Steffen Schneider  15 , Jochen Senges  15 , Ibrahim Akin  16
Affiliations
Multicenter Study

Left atrial appendage closure in patients with chronic kidney disease: results from the German multicentre LAARGE registry

Christian Fastner et al. Clin Res Cardiol. 2021 Jan.

Abstract

Objectives: Chronic kidney disease (CKD) is associated with an increased complication rate after cardiac interventions. Although CKD has a high prevalence among atrial fibrillation patients, the impact of CKD on periprocedural complications and the outcome after an interventional left atrial appendage closure (LAAC) is unclear. The present study, therefore, aimed to investigate whether CKD influences the procedure's effectiveness and safety.

Methods: LAARGE is a prospective, non-randomised registry. LAAC was conducted with different standard commercial devices, and the follow-up period was one year. CKD was defined by an eGFR < 60 mL/min/1.73 m2, and subgroups were further analysed (i.e. eGFR < 15, 15-29, and 30-59 mL/min/1.73 m2, respectively).

Results: Two hundred ninety-nine of 623 patients (48.0%) revealed a CKD. The prevalence of cardiovascular comorbidity, CHA2DS2-VASc score (4.9 vs. 4.2), and HAS-BLED score (4.3 vs. 3.5) was significantly higher in CKD patients (each p < 0.001). Implantation success was similarly high across all GFR groups (97.9%). Periprocedural MACCE (0.7 vs. 0.3%), and other major complications (4.7 vs. 3.7%) were comparably infrequent. Survival free of stroke was significantly lower among CKD patients within 1 year (82.0 vs. 93.0%; p < 0.001; consistent after adjustment for confounding factors), without significant accentuation in advanced CKD (i.e. eGFR < 30 mL/min/1.73 m2; p > 0.05 vs. eGFR 30-59 mL/min/1.73 m2). Non-fatal strokes were absolutely infrequent during follow-up (0 vs. 1.1%). Severe non-fatal bleedings were observed only among CKD patients (1.4 vs. 0%; p = 0.021).

Conclusions: Despite an increased cardiovascular risk profile of CKD patients, device implantation was safe, and LAAC was associated with effective stroke prevention across all CKD stages.

Keywords: Atrial fibrillation; Chronic kidney disease; LAARGE; Left atrial appendage; Left atrial appendage closure.

PubMed Disclaimer

Conflict of interest statement

Johannes Brachmann reports grants and personal fees from Biotronik (Berlin, Germany), Medtronic (Dublin, Ireland), Pfizer (New York City, NY, USA), and St. Jude Medical (Saint Paul, MN, USA). Horst Sievert reports study honoraria to institution, reimbursement of travel expenses, and consulting fees (personal honoraria had not been paid) from Abbott (Chicago, IL, USA), Boston Scientific (Marlborough, MA, USA), Lifetech (Nanshan District, Shenzhen, China), and Occlutech (Jena, Germany). Matthias Hochadel, Steffen Schneider, and Jochen Senges report unrestricted grants from Boston Scientific (Marlborough, MA, USA) for performing statistical analyses. Christian Fastner, Thorsten Lewalter, Uwe Zeymer, Martin Borggrefe, Christoph A. Nienaber, Christian Weiß, Sven T. Pleger, Hüseyin Ince, Jens Maier, Stephan Achenbach, Holger H. Sigusch, and Ibrahim Akin do not report any relevant conflicts of interest.

Figures

Fig. 1
Fig. 1
One-year incidence of all-cause death and stroke after left atrial appendage closure (LAAC). Left figure: freedom from all-cause death and stroke after left atrial appendage closure; right figure: freedom from all-cause death after LAAC
Fig. 2
Fig. 2
Adjustment of the primary efficacy outcome measure for relevant risk factors
See this image and copyright information in PMC

References

    1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609–1678. doi: 10.1093/europace/euw295. - DOI - PubMed
    1. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61(2):755–759. doi: 10.1016/0003-4975(95)00887-X. - DOI - PubMed
    1. Alamneh EA, Chalmers L, Bereznicki LR. Suboptimal use of oral anticoagulants in atrial fibrillation: has the introduction of direct oral anticoagulants improved prescribing practices? Am J Cardiovasc Drugs. 2016 doi: 10.1007/s40256-016-0161-8. - DOI - PubMed
    1. D'Ancona G, Safak E, Ince H. Left atrial appendage occlusion in patients with atrial fibrillation and high risk of fall: a clinical dilemma or a budgetary issue? Clin Res Cardiol. 2019;108(12):1406–1407. doi: 10.1007/s00392-019-01476-0. - DOI - PubMed
    1. Reddy VY, Mobius-Winkler S, Miller MA, Neuzil P, Schuler G, Wiebe J, Sick P, Sievert H. Left atrial appendage closure with the Watchman device in patients with a contraindication for oral anticoagulation: the ASAP study (ASA plavix feasibility study with watchman left atrial appendage closure technology) J Am Coll Cardiol. 2013;61(25):2551–2556. doi: 10.1016/j.jacc.2013.03.035. - DOI - PubMed

Publication types