Five-Year Outcomes and Cardiac Remodeling Following Left Atrial Appendage Occlusion

Figures & data

Table 1 Baseline Characteristics of Patients Stratified by the Types of LAAO Devices

Variables	Total (n=107)	LAmbre (n=59)	Lefort (n=25)	WATCHMAN (n=9)	Leftear (n=14)
Age (years)	70.7±9.5	71.2±9.5	71.2±7.7	67.2±14.5	70.0±8.8
Age ≥ 75 yrs (%, n)	48.6% (52)	23.4% (25)	13.1% (14)	3.7% (4)	8.4% (9)
Male/Female	54/53	28/31	12/13	6/3	8/6
Persistent AF (%, n)	72.9% (78)	11.2% (12)	48.6% (52)	3.7% (4)	9.3% (10)
SBP (mmHg)	134.3±16.7	134.5±16.0	134.2±16.4	137.6±23.4	131.6±16.6
DBP (mmHg)	77.4±13.6	79.5±13.4	74.6±13.6	76.4±18.0	74.4±11.1
CHF (%, n)	26.2% (28)	3.7% (4)	7.5% (8)	6.5% (7)	8.4% (9)
Hypertension (%, n)	56.1% (60)	35.5% (38)	14.0% (15)	3.7% (4)	2.8% (3)
Diabetes (%, n)	30.8% (33)	11.2% (12)	6.5% (7)	5.6% (6)	7.5% (8)
Prior Stroke/TIA (%, n)	50.4% (55)	34.6% (37)	9.3% (10)	1.9% (2)	4.7% (5)
Lipid disorders (%, n)	29.0% (31)	3.7% (4)	9.3% (10)	6.5% (7)	9.3% (10)
Warfarin (%, n)	41.1% (44)	15.9% (17)	8.4% (9)	5.6% (6)	11.2% (12)
Aspirin (%, n)	19.6% (21)	9.3% (10)	7.5% (8)	0.9% (1)	1.9% (1)
Clopidogrel (%, n)	15.0% (16)	5.6% (6)	6.5% (7)	1.9% (2)	0.9% (1)
Statins (%, n)	15.9% (17)	6.5% (7)	3.7% (4)	0	5.6% (6)
Nitrates (%, n)	24.3% (26)	5.6% (6)	6.5% (7)	5.6% (6)	6.5% (7)
Amiodarone (%, n)	40.2% (43)	8.4% (9)	12.1% (13)	6.5% (7)	13.1% (14)
ACEI/ARB (%, n)	48.6% (52)	26.2% (28)	11.2% (12)	5.6% (6)	5.6% (6)
Beta-blocker (%, n)	18.7% (20)	7.5% (8)	7.5% (8)	2.8% (3)	0.9% (1)
Diuretics (%, n)	29.9% (32)	7.5% (8)	12.1% (13)	4.7% (5)	5.6% (6)
CCB (%, n)	37.4% (40)	15.0% (16)	10.3% (11)	5.6% (6)	6.5% (7)
Digoxin (%, n)	29.9% (32)	4.7% (5)	5.6% (6)	7.5% (8)	12.1% (13)
CHADS2 Score	2.67±1.45	2.42±1.42	2.40±1.66	3.67±1.41	3.57±1.40
CHA2DS2-VAS Score	4.21±1.97	3.90±1.77	3.76±2.28	5.33±1.58	5.57±1.42
HAS-BLED Score	3.08±1.53	3.27±1.68	2.84±1.43	2.89±1.27	2.86±1.23
NYHA (I/II/III)	63/28/15	41/10/7	17/5/3	2/6/1	3/7/4
Post-intervention antithrombotic regimen
Post-intervention to 24h: enoxaparin (%, n)	100.0% (107)	100.0% (59)	100.0% (25)	100.0% (9)	100.0% (14)
Post-intervention to 3 months: aspirin combined with clopidogrel (%, n)	100.0% (107)	100.0% (59)	100.0% (25)	100.0% (9)	100.0% (14)
Three months after the intervention: aspirin or clopidogrel (%, n)	100.0% (107)	100.0% (59)	100.0% (25)	100.0% (9)	100.0% (14)

Abbreviations: LAAO, left atrial appendage occlusion; SBP, systolic blood pressure; DBP, diastolic blood pressure; AF, atrial fibrillation; CHF, congestive heart failure; TIA, transient ischemic attack; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CCB, Calcium channel blockers; NYHA; New York Heart Association.

Figure 1 Flow diagram of the present study.

Abbreviations: LAA, left atrial appendage; TEE, transesophageal echocardiography.

Table 2 Echocardiographic Variables According to Follow-Up Visits

Variables	Pre-Intervention	Follow-Up at 6 Months	P-value*	Follow-Up at 12 Months	P-value^†	Follow-Up at 24 Months	P-value^‡	Follow-Up at 36 Months	P-value^§
Aortic root diameter (mm)	34.3±3.6	34.8±3.9	0.711	34.7±3.5	0.022	35.5±3.5	0.118	34.5±4.0	0.167
LA AP diameter (mm)	46.5±7.0	48.6±6.7	0.016	47.0±6.3	0.087	46.6±5.7	0.617	46.0±5.6	0.393
LVEDD (mm)	47.3±5.1	48.4±5.2	0.223	47.3±5.1	0.690	48.4±4.1	0.277	46.4±4.5	0.828
LVESD (mm)	31.4±5.4	31.7±6.7	0.170	31.2±6.0	0.150	31.5±5.2	0.208	30.2±4.5	0.095
IVSWT (mm)	10.3±2.1	10.2±1.4	0.776	10.2±1.9	1.000	11.2±3.0	0.684	11.0±3.0	0.148
LVPWT (mm)	9.8±1.3	10.0±1.1	0.358	10.0±1.2	0.727	10.4±1.0	0.299	10.3±1.9	0.714
LVEF (%)	59.8±8.4	60.4±8.2	0.382	59.8±7.2	0.930	58.0±6.1	0.678	60.1±7.6	0.123

Notes: Values are presented as mean ± SD. *P-value represents a comparison between follow-up at 6 months versus pre-intervention for echocardiographic variables after LAAO operation. ^†P-value represents a comparison between follow-up at 12 months versus pre-intervention for echocardiographic variables after LAAO operation. ^‡P-value represents a comparison between follow-up at 24 months versus pre-intervention for echocardiographic variables after LAAO operation. ^§P-value represents a comparison between follow-up at 36 months versus pre-intervention for echocardiographic variables after LAAO operation.

Abbreviations: LVEDD, left ventricular end-diastolic dimension; LVESD, left ventricular end-systolic dimension; IVSWT, interventricular septal wall thickness; LVPWT, left ventricular posterior wall thickness; LVEF, left ventricular ejection fraction; LA, left atrium; AP, anteroposterior.

Table 3 The Comparison Between Each Follow-Up Time Point and Pre-Intervention ECG Data

Variables	Pre-Intervention	Post-Intervention	P-value*	Follow-Up at 6 Months	P-value^†	Follow-Up at 12 Months	P-value^‡	Follow-Up at 24 Months	P-value^§
Heart rate (bpm)	85.3±21.7	78.5±14.7	0.007	82.1±16.2	0.830	84.8±16.5	0.675	85.5±20.9	0.052
QRS interval (ms)	104.6±28.2	99.6±26.0	0.561	101.0±33.7	0.132	100.1±25.5	0.370	100.9±27.9	0.713
QT interval (ms)	386.3±51.7	398.5±50.7	0.016	400.0±56.7	0.883	376.4±71.1	0.143	358.4±49.8	0.188
QTc (ms)	433.7±49.0	443.1±46.3	0.182	460.7±46.8	0.036	452.8±45.7	0.381	420.3±47.1	0.178
QRS axis (degrees)	20.6±39.7	26.6±39.5	0.084	29.3±45.2	0.281	23.8±43.8	0.851	37.2±30.5	0.443

Notes: *P-value represents the comparison between post-intervention versus pre-intervention for ECG variables after LAAO intervention. ^†P-value represents the comparison between follow-up at 6 months versus pre-intervention for ECG variables after LAAO intervention. ^‡P-value represents the comparison between follow-up at 12 months versus pre-intervention for ECG variables after LAAO intervention. ^§P-value represents the comparison between follow-up at 24 months versus pre-intervention for ECG variables after LAAO intervention.

Table 4 The Clinical Outcomes in Patients with LAAO Within 5-Years Follow-Up

Events		Total (n=107)
Mean follow-up time (months)		42.7±16.8
1. MACEs
Cardiovascular mortality		3.7% (4)
Heart Failure		23.4% (25)
Stroke/systemic embolism		10.3% (11)
Systemic embolism		10.3% (11)
2. Secondary endpoints
Puncture site complications		6.5% (7)
All-cause mortality		7.5% (8)
Pericardial effusion	1-year	13.1% (14)
	2-year	7.5% (8)
	3-year	5.6% (6)
Bleeding		6.5% (7)

Abbreviations: LAAO, left atrial appendage occlusion; MACE, major adverse cardiovascular events.

Figure 2 Survival analysis regarding MACE at 5 years of follow-up according to (A) Types of LAAO devices, (B) gender, and (C) age.