Key result
Non-paroxysmal atrial fibrillation was associated with an increased risk of death, stroke, or systemic embolism at one year compared to paroxysmal atrial fibrillation in patients undergoing left atrial appendage closure (HR 1.67).
Why the study?
Non-paroxysmal forms of AF have been associated with an increased risk for systemic embolism or death.
Does non-paroxysmal atrial fibrillation compared to paroxysmal atrial fibrillation increase the risk of mortality and thromboembolic events in patients undergoing left atrial appendage closure?
Observational (n=638)
Yes
Does non-paroxysmal atrial fibrillation compared to paroxysmal atrial fibrillation increase the risk of mortality and thromboembolic events in patients undergoing left atrial appendage closure?
Hazard Ratio: 1.67 (95% CI 1.02–2.72)
Absolute Event Rate: 15.1% vs 8.8%
p-value: p=0.041
In patients undergoing left atrial appendage closure, non-paroxysmal atrial fibrillation is associated with a significantly higher one-year risk of mortality and thromboembolic events compared to paroxysmal atrial fibrillation.
May warrant closer post-LAA closure monitoring in non-paroxysmal AF; leaves open whether tailored therapy improves outcomes.
Background Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. Methods Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). Results A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p = 0.041). Conclusion Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality. Graphic abstract
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Kany et al. (2021) conducted an observational in Atrial fibrillation (n=638). Non-paroxysmal atrial fibrillation vs. Paroxysmal atrial fibrillation was evaluated on Composite of death, stroke, and systemic embolism at 1 year (HR 1.67, 95% CI 1.02-2.72, p=0.041). Non-paroxysmal atrial fibrillation was associated with an increased risk of death, stroke, or systemic embolism at one year compared to paroxysmal atrial fibrillation in patients undergoing left atrial appendage closure (HR 1.67).
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