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. 2024 Oct 30;13(21):6514.
doi: 10.3390/jcm13216514.

Left Atrial Appendage Closure in Atrial Fibrillation Patients with Cancer

David Zweiker  1   2 , Jutta Bergler-Klein  3 , Lukas Fiedler  4 , Gabor G Toth  1 , Reinhard Achleitner  5 , Alexandra Schratter  5 , Guenter Stix  3 , Harald Gabriel  3 , Ronald K Binder  6 , Martin Rammer  6 , Michael Pfeffer  4 , Paul Vock  7 , Brigitte Lileg  7 , Clemens Steinwender  8 , Kurt Sihorsch  8 , Florian Hintringer  9 , Agne Adukauskaite  9 , Martin Martinek  10 , Thomas Sturmberger  10 , Klemens Ablasser  1 , Andreas Zirlik  1 , Daniel Scherr  1   11
Affiliations

Left Atrial Appendage Closure in Atrial Fibrillation Patients with Cancer

David Zweiker et al. J Clin Med. .

Abstract

Background: There are limited data about left atrial appendage closure (LAAC) in patients with cancer. We therefore sought to compare the outcome after LAAC in patients with vs. without cancer in a multicentre registry. Methods: In this sub-analysis of the prospective Austrian LAAC Registry, we analysed consecutive patients undergoing LAAC to assess the relationship between baseline characteristics and outcome in patients with vs. without cancer. Inverse probability weighting was performed to adjust for differences in baseline characteristics. Results: A total of 486 consecutive patients from 9 centres with a median age of 75 years (IQR 70-79 years; 35.8% female) were included. Fifty-seven patients (11.7%) had a history of cancer. The median CHA2DS2-VASc and HAS-BLED scores were similar in both groups (median [IQR], 4 [4-6] vs. 5 [3-5], p = 0.415; 4 [3-4] vs. 3 [3-4], p = 0.428 in cancer vs. other patients). Cancer patients were significantly older, and anaemia and gastrointestinal bleeding were significantly more common. Major procedural complications occurred in 5.3% vs. 7.0% (p = 0.276) of patients. The cumulative five-year survival rates were 80.7% and 84.8% in cancer vs. other patients (adjusted hazard ratio for death 1.29 [95% CI 0.67-2.48], p = 0.443). There were also no differences in one-year survival (96.1% vs. 94.0%, p = 0.582) and five-year event-free survival (64.9% vs. 74.4%, p = 0.124). Conclusions: In daily clinical practice, LAAC has already been accepted as a treatment option in patients with cancer. This retrospective analysis shows that short-term and adjusted long-term complications are similar in patients with vs. without cancer undergoing LAAC.

Keywords: anticoagulation; atrial fibrillation; cancer; cardio-oncology; complications; left atrial appendage closure; malignancy.

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Conflict of interest statement

Gabor G. Toth: consulting fees from Abbott, Medtronic, Terumo and Biotronik; David Zweiker: consulting fees from Daiichi Sankyo, unrestricted grant from Boston Scientific; Harald Gabriel: consulting fees from Abbott, Ronald K Binder: proctor for Boston Scientific, speaker fees from Abbott and travel support from Boston Scientific and Abbott; Florian Hintringer: proctor for Abbott. All remaining authors report no conflicts of interest whatsoever.

Figures

Figure 1
Figure 1
Non-adjusted five-year survival curves for patients with vs. without cancer. (A): five-year survival; (B): five-year survival free from long-term adverse events (embolism, stroke, bleeding, LAAC-related hospitalisation).
See this image and copyright information in PMC

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