Left atrial appendage closure in end‐stage renal disease and hemodialysis: Data from a German multicenter registry

Background Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). OAC treatment has been proven feasible in mild‐to‐moderate chronic kidney disease (CKD). In contrast, the optimal antithromboti...

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Published in:Catheterization and cardiovascular interventions 2023-02, Vol.101 (3), p.610-619
Main Authors: Fink, Thomas, Paitazoglou, Christina, Bergmann, Martin W., Sano, Makoto, Keelani, Ahmad, Sciacca, Vanessa, Saad, Mohammed, Eitel, Charlotte, Heeger, Christian‐Hendrik, Skurk, Carsten, Landmesser, Ulf, Thiele, Holger, Stiermaier, Thomas, Fuernau, Georg, Reil, Jan‐Christian, Frey, Norbert, Kuck, Karl‐Heinz, Tilz, Roland R., Sandri, Marcus, Eitel, Ingo
Format: Article
Language:English
Subjects:
Anticoagulants - adverse effects
Atrial Appendage - diagnostic imaging
Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Atrial Fibrillation - therapy
chronic kidney disease
Clinical trials
Embolism
Glomerular filtration rate
Hemodialysis
Humans
Ischemia
Kidney diseases
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - therapy
left atrial appendage closure
Patients
Prospective Studies
Registries
Renal Dialysis - adverse effects
renal failure
Renal Insufficiency, Chronic - complications
Renal Insufficiency, Chronic - diagnosis
Renal Insufficiency, Chronic - therapy
Stroke
Stroke - etiology
Stroke - prevention & control
Transient ischemic attack
Treatment Outcome
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Summary:Background Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation (AF). OAC treatment has been proven feasible in mild‐to‐moderate chronic kidney disease (CKD). In contrast, the optimal antithrombotic management of AF patients with end‐stage renal disease (ESRD) is unknown and LAAC has not been proven in these patients in prospective randomized clinical trials. Objectives The objective of this study is to evaluate safety and efficacy of LAAC in patients with ESRD. Methods Patients undergoing LAAC were collected in a German multicenter real‐world observational registry. A composite endpoint consisting of the occurrence of ischemic stroke/transient ischemic attack, systemic embolism, and/or major clinical bleeding was assessed. Patients with ESRD were compared with propensity score‐matched patients without severe CKD. ESRD was defined as a glomerular filtration rate 
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.30559