Key result
Following left atrial appendage occlusion, females experienced significantly higher rates of net adverse events (4.73% vs 4.24%, P<0.001) and mortality (0.23% vs 0.15%, P=0.041) compared to males.
Why the study?
Females have been underrepresented in landmark trials supporting LAAO use, leaving gender differences in outcomes after LAAO device placement unclear.
Does female sex increase the risk of adverse events and mortality following left atrial appendage occlusion device placement compared to male sex?
Cohort (n=89,552)
Yes
Does female sex increase the risk of adverse events and mortality following left atrial appendage occlusion device placement compared to male sex?
Females undergoing left atrial appendage occlusion device placement experience significantly higher rates of periprocedural adverse events, mortality, and readmissions compared to males.
Background Atrial fibrillation (AF) is associated with profound morbidity and mortality, including a fivefold increase in stroke risk. Left atrial appendage occlusion (LAAO) devices have emerged as an alternative approach to anticoagulation in patients with elevated bleeding risk and/or have contraindications to anticoagulation. However, females have been underrepresented in PROTECT & PREVAIL landmark trials supporting LAAO use. We aim to compare gender differences in outcomes of LAAO occlusive devices. Methods The national readmission database (2016–2020) was utilized to identify hospitalizations for LAAO placement. Cohorts were stratified by gender as males and females. A propensity score matching (PSM) model matched both cohorts. Pearson's x2 test was applied to the matched cohorts to compare outcomes. Results Among 89,552 hospitalizations for LAAO placement, 41.3% of procedures were performed in females. Females were found to have a lower prevalence of co‐morbidities such as diabetes, hypertension, hyperlipidemia and CKD [ p < 0.001]. After propensity matching ( N = 20,627), females had higher adverse events, including mortality (0.23% vs. 0.15%, p : 0.041), sudden cardiac arrest (1.77% vs. 1.37%, p : 0.001), pericardial complications (1.46% vs. 0.86%, p < 0.001), cardiac tamponade (0.94% vs. 0.54%, p < 0.001), post‐procedural bleeding (0.69% vs. 0.53%, p : 0.032) & net adverse events (4.73% vs. 4.24%, p < 0.001). At six‐month follow‐up post‐procedure, females had higher readmission rates at 30 days (9.42% vs. 8.07%, p < 0.001), 90‐day and 180‐day intervals ( p < 0.001). Conclusion In patients with hospitalizations for LAAO device placement, we observed a higher risk of net adverse events and mortality in females following the procedure compared to males. Prospective trials are warranted to identify and stratify the at‐risk population with extensive preprocedural evaluation and determine ways to mitigate the sex‐related disparities in clinical outcomes following the LAAO procedure.
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Ali et al. (2026) conducted a cohort in Atrial fibrillation requiring left atrial appendage occlusion (n=89,552). Left atrial appendage occlusion in females vs. Left atrial appendage occlusion in males was evaluated on Net adverse events (p=<0.001). Following left atrial appendage occlusion, females experienced significantly higher rates of net adverse events (4.73% vs 4.24%, P<0.001) and mortality (0.23% vs 0.15%, P=0.041) compared to males.
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