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Randomized Controlled Trial
. 2025 Feb;27(2):285-292.
doi: 10.1002/ejhf.3536. Epub 2024 Nov 25.

Heart failure after left atrial appendage occlusion: Insights from the LAAOS III randomized trial

Philipp Krisai  1 , Emilie P Belley-Cote  2   3   4 , William F McIntyre  2   3   4 , Jorge Wong  2   3   4 , Kate Tsiplova  2 , Katheryn Brady  2   3   4 , Philip Joseph  2   3   4 , Isabelle Johansson  4   5 , Linda Johnson  4   6 , Lucas Yixi Xing  7 , Andrea Colli  8 , Shay McGuinness  9 , Prakash Punjabi  10 , Wilko Reents  11 , Filip Rega  12 , Petr Budera  13 , Alistair G Royse  14 , Domenico Paparella  15 , Stuart Connolly  2   3   4 , Richard P Whitlock  2   3   4 , Jeff S Healey  2   3   4 ; on behalf of the LAAOS III Investigators
Affiliations
Randomized Controlled Trial

Heart failure after left atrial appendage occlusion: Insights from the LAAOS III randomized trial

Philipp Krisai et al. Eur J Heart Fail. 2025 Feb.

Abstract

Aims: The left atrial appendage (LAA) produces natriuretic peptides and its removal or occlusion might increase the risk of heart failure (HF). We aimed to investigate the incidence of HF after LAA occlusion or removal (LAAO) in the Left Atrial Appendage Occlusion Study (LAAOS III).

Methods and results: Patients (n = 4811) with atrial fibrillation (AF) and a CHA2DS2-VASc score ≥2, who were having cardiac surgery for another indication, were randomized to undergo surgical LAAO or not. We compared the composite outcome of HF-related hospitalizations and HF death between the two groups. HF assessment required clinical and radiographic evidence of HF. Analyses included a landmark analysis before and after 30 days and subgroups. Mean age was 71.2 years, 67.5% were male and 57.0% had prior HF. Over a mean follow-up of 3.8 years, 396 (8.3%) patients met the composite HF outcome: 209 (8.8%) with LAAO (n = 2379) and 187 (7.8%) without LAAO (n = 2391) (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.92-1.37, p = 0.25). There was no difference between the two groups in the first 30 days (1.6% vs. 1.1%; p = 0.12) and thereafter (7.6% vs. 7.1%; p = 0.57). Subgroups based on age, sex, body mass index, AF type, prior HF, cardiac rhythm or left ventricular ejection fraction showed consistent results. There was no difference in HF outcomes with LAAO between the cut-and-sew (HR 0.93, 95% CI 0.70-1.23, p = 0.62) versus other closure methods (HR 1.05, 95% CI 0.77-1.41, p = 0.77).

Conclusions: Left atrial appendage occlusion or removal at the time of cardiac surgery does not appear to alter the risk of HF-related hospitalization or death.

Clinical trial registration: ClinicalTrials.gov NCT01561651.

Keywords: Atrial fibrillation; Heart failure; Left atrial appendage; Left atrial appendage occlusion.

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Figures

Figure 1
Figure 1
Cumulative incidence for the primary heart failure outcome.
Figure 2
Figure 2
Landmark analyses for the primary heart failure outcome in the first 30 days (A) and thereafter (B).
Figure 3
Figure 3
Subgroup analysis for the primary heart failure outcome. AF, atrial fibrillation; BMI, body mass index; CI, confidence interval; LAA, left atrial appendage; LAAO, left atrial appendage occlusion; LVEF, left ventricular ejection fraction.
Figure 4
Figure 4
Cumulative incidence for the primary heart failure outcome in patients with left ventricular ejection fraction ≥50% (A) and <50% (B).
See this image and copyright information in PMC

References

    1. Whitlock R, Healey J, Vincent J, Brady K, Teoh K, Royse A, et al. Rationale and design of the Left Atrial Appendage Occlusion Study (LAAOS) III. Ann Cardiothorac Surg 2014;3:45–54. 10.3978/j.issn.2225-319X.2013.12.06 - DOI - PMC - PubMed
    1. Whitlock RP, Belley‐Cote EP, Paparella D, Healey JS, Brady K, Sharma M, et al. LAAOS III Investigators. Left atrial appendage occlusion during cardiac surgery to prevent stroke. N Engl J Med 2021;384:2081–2091. 10.1056/NEJMoa2101897 - DOI - PubMed
    1. Healey JS, Oldgren J, Ezekowitz M, Zhu J, Pais P, Wang J, et al.; RE‐LY Atrial Fibrillation Registry and Cohort Study Investigators . Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: A cohort study. Lancet 2016;388:1161–1169. 10.1016/S0140-6736(16)30968-0 - DOI - PubMed
    1. Patel NJ, Deshmukh A, Pant S, Singh V, Patel N, Arora S, et al. Contemporary trends of hospitalization for atrial fibrillation in the United States, 2000 through 2010: Implications for healthcare planning. Circulation 2014;129:2371–2379. 10.1161/CIRCULATIONAHA.114.008201 - DOI - PubMed
    1. Tabata T, Oki T, Yamada H, Iuchi A, Ito S, Hori T, et al. Role of left atrial appendage in left atrial reservoir function as evaluated by left atrial appendage clamping during cardiac surgery. Am J Cardiol 1998;81:327–332. 10.1016/s0002-9149(97)00903-x - DOI - PubMed

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