Introduction: Gender-based differences in atrial fibrillation have been identified, but limited data exist for patients undergoing left atrial appendage occluder (LAAO) implantation. This study reports gender-related periprocedural and 1-year outcomes of the prospective, multicenter German left atrial appendage occlusion registry (LAARGE). 

Methods: LAARGE enrolled 641 patients who were scheduled for LAAO implantation from July 2014 to January 2016 in 38 hospitals in Germany. The data collected included demographics, clinical characteristics, details of implantation and outcome. Efficacy and safety at 1-year follow-up were assessed by the occurrence of thrombembolic and bleeding events, as well as mortality. 

Results: Of 638 patients undergoing LAAO implantation 38.9% were female and 61.1% male.

Females were older (76.4 ± 8.2 [females] vs 75.6 ± 7.7 [males], p=0.042) and had a higher stroke risk (CHA₂DS₂-VASc score: 4.9±1.5 vs 4.3±1.5, p<0.001). In contrast, males suffered more often from coronary artery (33.1% vs 53.8%, p<0.001) and vascular disease (18.5% vs 31.0%, p<0.001). Technical success was high and similar for both genders (98.4% vs 97.2%, p=0.33). Severe periprocedural complications (6.9% vs 3.1%, p=0.032) occurred more often in females. At 1-year follow-up the rates of all-cause stroke (0.5% vs 1.3%, p=0.65) and severe bleeding (0.0% and 1.0%, p=0.29) were low and comparable between the genders. Also, one-year all-cause mortality (9.2% vs 13.1%, p=0.14) did not differ significantly. 

Conclusion: LAARGE documented in this elderly patient population undergoing LAAO implantation a higher rate of severe periprocedural complications in females. At 1-year follow-up similar efficacy and safety outcomes were observed for both genders.