September 1, 2025Heart Rhythm O2Open Access

Real-world outcomes of left atrial appendage closure in very elderly compared with younger patients

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Why the study?

Data on the outcomes and usefulness of left atrial appendage occlusion in the very elderly with AF are limited.

Does left atrial appendage occlusion have similar safety and efficacy outcomes in very elderly patients compared to younger patients?

Structured PICO

Does left atrial appendage occlusion have similar safety and efficacy outcomes in very elderly patients compared to younger patients?

Population

Patients with atrial fibrillation undergoing left atrial appendage occlusion, specifically comparing very elderly (≥85 years, average 88.1 years) with younger patients (<85 years, average 76.7 years) at a single US hospital center.

Intervention

Left atrial appendage occlusion (LAAO) in very elderly patients (≥85 years)

Comparator

Left atrial appendage occlusion (LAAO) in younger patients (<85 years)

Outcome

Successful procedures (at implant), procedural complications, 45-day device-related readmission, device-related thrombus (DRT), stroke, and death within 1 yearhard clinical

LAAO appears safe and effective in very elderly patients (≥85 years) with low complication rates comparable to younger patients, despite a trend toward higher 1-year mortality.

Implication

May support LAAO consideration in very elderly; hypothesis-generating and requires randomized confirmation of mortality trends.

Abstract

Background: Left atrial appendage occlusion (LAAO) has become an attractive alternative to chronic anticoagulation in the very elderly with atrial fibrillation (AF). Data on the outcomes and usefulness of this procedure in this population are limited. Objective: The purpose of this study was to analyze the real-world outcomes of LAAO in the very elderly. Methods: The outcomes of LAAO implantation in very elderly patients aged ≥85 years (average 88.1 years) compared with those in younger patients aged <85 years (average 76.7 years), from a single hospital center serving one of the oldest communities in the United States, were retrospectively analyzed. Successful procedures (at implant), procedural complications, 45-day device-related readmission, device-related thrombus (DRT), stroke, and death within 1 year were examined. Results: = .09). Conclusion: LAAO is as safe and effective in the very elderly as in the younger population and may be performed with a very low complication rate. There is a trend toward increased 1-year mortality in the very elderly.