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Multicenter Study
. 2025 Jan;11(1):71-82.
doi: 10.1016/j.jacep.2024.09.038.

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

Lukas Urbanek  1 , Gunnar H Heine  2 , Claudia Reddavid  3 , Jacqueline Saw  3 , Iwanari Kawamura  4 , Vivek Y Reddy  4 , Roberto Galea  5 , Lorenz Räber  5 , Alexander Sedaghat  6 , Domenico G Della Rocca  7 , Andrea Natale  8 , Gaetano Fassini  9 , Claudio Tondo  9 , Shephal K Doshi  10 , Dorothy S Peng  10 , Ralph Stephan von Bardeleben  11 , Felix Kreidel  12 , Boris Schmidt  13
Affiliations
Multicenter Study

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

Lukas Urbanek et al. JACC Clin Electrophysiol. 2025 Jan.

Abstract

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.

Keywords: anticoagulation; atrial fibrillation; hemodialysis; left atrial appendage closure; stroke.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Reddy has received consulting fees from Abbott, Append Medical, and Boston Scientific; has equity in Laminar; and unrelated to this manuscript has received consulting fees from and has equity in Ablacon, Acutus Medical, Affera-Medtronic, Anumana, Apama Medical-Boston Scientific, APN Health, Aquaheart, Atacor, Autonomix, Axon Therapies, Backbeat, BioSig, CardiaCare, CardioNXT/AFTx, Circa Scientific, CoRISMA, Corvia Medical, Dinova-Hangzhou DiNovA EP Technology, East End Medical, EPD-Philips, EP Frontiers, Epix Therapeutics-Medtronic, EpiEP, Eximo, Farapulse, Field Medical, Focused Therapeutics, HRT, Intershunt, Javelin, Kardium, Keystone Heart, LuxMed, Medlumics, Middlepeak, Neutrace, Nuvera-Biosense Webster, Oracle Health, Restore Medical, Sirona Medical, SoundCath, and Valcare; and unrelated to this work has received consulting fees from Adagio Medical, AtriAN, Biosense-Webster, BioTel Heart, Biotronik, Cairdac, Cardiofocus, Cardionomic, CoreMap, Fire1, Gore and Associates, Impulse Dynamics, Medtronic, Novartis, Philips, and Pulse Biosciences; and unrelated to this work has equity in Atraverse, Manual Surgical Sciences, Newpace, Nyra Medical, Surecor, and Vizaramed. Dr Natale has received consulting fees from Abbott, Biosense Webster, Biotronik, Boston Scientific, and iRhythm. Dr Schmidt has received speaking and proctoring honoraria from Medtronic, Biosense Webster, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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