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December 23, 2022Cardiovascular Intervention and TherapeuticsOpen Access

Percutaneous left atrial appendage closure demonstrated a 100% procedural success rate in hemodialysis patients, with no significant difference in major complications compared to non-hemodialysis patients at 45 days.

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Why the study?

In countries where anticoagulation is not recommended in hemodialysis patients, the feasibility of percutaneous LAAC in hemodialysis patients with NVAF and high risks of thromboembolic stroke and bleeding remains unknown.

Does percutaneous left atrial appendage closure have comparable safety and short-term feasibility in hemodialysis patients compared to non-hemodialysis patients with non-valvular atrial fibrillation and high bleeding risk?

Population

118 NVAF patients (25 hemodialysis and 93 non-hemodialysis)

Comparison

Hemodialysis vs non-hemodialysis patients undergoing LAAC with WATCHMAN

Design

Retrospective single-institute comparative study

Follow-up

45-day observational period

Key result

Percutaneous left atrial appendage closure demonstrated a 100% procedural success rate in hemodialysis patients, with no significant difference in major complications compared to non-hemodialysis patients at 45 days.

Authors

HUHiroshi UenoTITeruhiko ImamuraSTShuhei Tanaka

Discussion

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Member takes

Overview

May support LAAC feasibility in high-risk Japanese hemodialysis patients with NVAF; hypothesis-generating and leaves open need for prospective trials.

Study Design

Type

Cohort (n=118)

Multicenter

No

Structured PICO

Does percutaneous left atrial appendage closure have comparable safety and short-term feasibility in hemodialysis patients compared to non-hemodialysis patients with non-valvular atrial fibrillation and high bleeding risk?

P
Population
118 patients (median age 79, 31.4% female) with non-valvular atrial fibrillation and high bleeding risk, including 25 on hemodialysis, who underwent left atrial appendage closure and were followed for 45 days.
E
Exposure
Percutaneous left atrial appendage closure (LAAC) using the WATCHMAN system (2.5 or FLX) in hemodialysis patients.
C
Comparator
Percutaneous LAAC using the WATCHMAN system in non-hemodialysis patients.
O
Outcome
Peri-procedural and 45-day clinical outcomes (procedure-related events, complications, device-related thrombus, residual peri-device flow >5 mm).safety

Main Result

Absolute Event Rate: 100% vs 99%

p-value: p=0.60

Percutaneous left atrial appendage closure appears feasible and safe in the short term for hemodialysis patients with non-valvular atrial fibrillation and high bleeding risk.

Limitations

  • Single-center study with a small sample size
  • Potential selection bias due to initial recommendations by cardiologists
  • Differences in baseline characteristics and procedure-related parameters between groups
  • Impact of using two different devices (WATCHMAN 2.5 and FLX) and operator learning curve
  • Different post-procedural medication regimens between the two groups
  • Short observational follow-up period of only 45 days
  • Single center
  • Small sample size
  • Differences in background and procedure-related parameters between groups
  • Selection bias
  • Impact of two different devices and learning curve
  • Different post-procedural medication regimens
  • Short observational period (45 days)

Cite This Study

Ueno et al. (2022) conducted a cohort in Non-valvular atrial fibrillation with high risk of bleeding (n=118). Hemodialysis (in patients undergoing left atrial appendage closure) vs. Non-hemodialysis was evaluated on Procedure success (p=0.60). Percutaneous left atrial appendage closure demonstrated a 100% procedural success rate in hemodialysis patients, with no significant difference in major complications compared to non-hemodialysis patients at 45 days.

synapsesocial.com/papers/6a9f603e45d480dbdfea33bdhttps://doi.org/10.1007/s12928-022-00904-9
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