Key result
Percutaneous LAAO achieves 98% procedural success with low long-term stroke and mortality rates in observational data.
Why the study?
Percutaneous LAAO data in South Africa were very limited, with no local outcome data previously reported.
What are the safety and efficacy outcomes of percutaneous LAAO in a South African cohort?
Observational (n=101)
No
What are the safety and efficacy outcomes of percutaneous LAAO in a South African cohort?
Percutaneous LAAO is feasible and safe in a South African context, with outcomes comparable to large international series.
Supports LAAO feasibility in South Africa; extends registry data to new setting but leaves confirmation to prospective trials.
BACKGROUND: Atrial fibrillation (AF) is associated with all-cause mortality, heart failure and non-fatal stroke, and thromboprophylaxis is traditionally provided with oral anticoagulants (OACs). Percutaneous left atrial appendage occlusion (LAAO) with a dedicated device is an alternative approach to thromboprophylaxis in patients with AF who are: (i) intolerant to OACs (e.g. life-threatening haemorrhage); (ii) non-adherent to OACs; or (iii) at a high bleeding risk with OACs. Non-inferiority of LAAO compared with OACs was demonstrated in e.g. the WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation (PROTECT AF) trial. Only very limited data are available on percutaneous LAAO in South Africa (SA), and no local outcome data have been reported. OBJECTIVES: To compare the safety and efficacy outcomes of an SA percutaneous LAAO programme with larger international series. METHODS: All patients undergoing percutaneous LAAO from 2013 to 2020 at a single centre (SAEndovascular, Kuils River Netcare Hospital, SA) were included from an ongoing registry. Survival analysis was performed with the Kaplan-Meier method. RESULTS: Of 101 LAAO recipients (mean (standard deviation) age 77 (10) years, 64% male) analysed, 90 (90%) had permanent AF, 1 (1%) persistent AF and 9 (9%) paroxysmal AF. The most common indication for LAAO was previous severe bleeding (n=23; 23%). The mean device size was 23 (3) mm and the procedural success rate was 98%. After a median (interquartile range) follow-up of 21 (5 - 41) months, 6 patients (6%) experienced stroke or all-cause mortality. Four patients (4%) had a life-threatening procedural complication (tamponade n=2 (2%) and device embolisation n=2 (2%)). These outcomes are comparable to large international series, e.g. PROTECT AF. CONCLUSIONS: The safety and efficacy outcomes of an SA percutaneous LAAO programme were comparable to large international series. A successful percutaneous LAAO programme is feasible in a southern African context.
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Dippenaar et al. (2022) conducted an observational in Atrial fibrillation (n=101). Percutaneous left atrial appendage occlusion (LAAO) was evaluated on Stroke or all-cause mortality. Percutaneous left atrial appendage occlusion in a South African registry achieved a 98% procedural success rate, with 6% of patients experiencing stroke or all-cause mortality over 21 months.
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