Left atrial appendage occlusion in cancer patients with atrial fibrillation had a 92.9% success rate and similar safety and efficacy to non-cancer patients over 52.8 months.
Does percutaneous LAAO have similar safety and efficacy in cancer patients with AF compared to those without cancer?
In real-world practice, LAAO is a safe and effective stroke prevention strategy for AF patients with a history of cancer, showing comparable outcomes to non-cancer patients.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Left atrial appendage occlusion (LAAO) is increasingly used to prevent stroke in patients with atrial fibrillation (AF), particularly those with contraindication to long-term anticoagulation. This approach is especially relevant for cancer patients, who not only face a high risk of thrombotic events but also potential complications with anticoagulant therapy. However, data on LAAO in this population are limited. Aim To evaluate the safety and efficacy of LAAO in cancer patients with AF compared to those without cancer. Methods Single-center retrospective study of patients who underwent percutaneous LAAO from November 2009 to December 2024. Procedure details, complications, CHA2DS2-VASc and HAS-BLED scores were analyzed. Adjustments for CHA2DS2-VASc and HAS-BLED scores ensured comparable groups. Efficacy was defined as stroke, systemic embolism or all-cause death. Safety endpoints included procedural complications and major bleeding events. Kaplan-Meier survival analysis was performed to evaluate the efficacy and safety outcomes. Results Among 215 patients, 42 had a history of cancer (13 gastrointestinal, 10 hematologic, 4 genitourinary). Of these, 15.9% had active cancer, while 84.1% had previous cancer. The mean age was 74.4±1.2 years, with 36% male; 55% had permanent AF, and 36% had a prior stroke. Median CHA2DS2-VASc and HAS-BLED scores were comparable between groups (4.1±0.2 vs. 4.1±0.1, p=NS; 3.2±0.2 vs. 3.0±0.1, p=NS). Referral reasons for LAAO in cancer patients included gastrointestinal bleeding (41%), high bleeding risk (14%), and anemia (10%). The procedure duration was 86.9±5.2 minutes, with a 92.9% success rate, similar to non-cancer patients. Watchman devices were implanted in 39 patients, Amulet devices in the rest, with an average size of 27±1 mm (p=NS). No acute procedural complications were observed in cancer patients. After the procedure, 26% of patients were on therapy with VKAs and aspirin (used until 2014), 46% were on dual antiplatelet therapy, and 14% were on NOACs, with no differences between the two groups. Major bleeding events occurred in 2 patients (1 genitourinary, 1 gastrointestinal), while minor bleeding events were reported in 7 cases (9 events in cancer patients vs. 22 events in non-cancer patients, p=0.12), as defined by the VARC 3 criteria. During a follow-up of 52.8±7.8 months, 18 cancer patients died (none from cardiovascular causes), and 1 patient had an ischemic stroke, representing 0.4% of the patients. No significant differences were found between cancer and non-cancer patients regarding safety (LogRank p=0.44) or efficacy outcomes (LogRank p=0.11). Conclusion In real-world practice, LAAO is a safe and effective option for cancer patients with AF, with similar outcomes to non-cancer patients. It should be considered a valuable strategy for managing these high-risk patients.
Araújo et al. (Sat,) reported a other. Left atrial appendage occlusion in cancer patients with atrial fibrillation had a 92.9% success rate and similar safety and efficacy to non-cancer patients over 52.8 months.