Background: Studies have shown that patients with atrial fibrillation (AF) and reduced left ventricular ejection fraction (LVEF) have more frequently thrombi in the left atrial cavity than patients with preserved LVEF. Therefore, one can assume that stroke risk reduction by left atrial appendage closure (LAAC) in these patients is less effective.

Aims: To evaluate the impact of LVEF on periprocedural complications and long-term thromboembolic events of interventional LAAC in patients with AF.

Methods: a retrospective single-center study including a total of 612 patients who underwent successful interventional LAAC were categorized into two groups (139 patients with reduced LVEF (EF <50%) and 473 patients with preserved LVEF (EF ≥ 50%). Baseline characteristics, in-hospital procedural complications and long-term thromboembolic events in the two groups were compared.

Results: Patients with reduced LVEF were more often female with higher median of CHA2DS2-VASc-Score (5 vs. 4, respectively; p<0.0001) with clinical history of diabetes mellitus (54% vs. 40 %, respectively; p 0.003), coronary heart disease (CHD)/peripheral artery disease (PAD) (68% vs. 41%, respectively; p<0.0001) and congestive heart failure (CHF) (92% vs. 5%, respectively; p<0.0001). Watchman implant was the device of choice in the study population. Compared to patients with preserved LVEF, there was no difference in procedure-related complications (bleeding, arteriovenous (AV) fistula, pseudoaneurysma, pericardial tamponade, TIA and stroke) or in-hospital deaths. Both groups had a similar median duration of long-term follow-up (20 [4-40] vs. 18.5 [3-50] months, respectively; p 0.13). During follow-up there was no difference in the incidences of TIA, stroke and systemic thromboembolic events between the two groups.

Conclusion: In patients with reduced LVEF, the procedural safety of LAAC and incidence of thromboembolic events were consistently low and comparable to patients with preserved LVEF.

Baseline characteristics

Variable	LV-EF < 50 (n=139)	LV-EF ≥ 50 (n=473)	p
Age [years], median (IQR)	74 (69-79)	74 (69-78)	0.69
Male gender, n (%)	32/139 (23%)	196/473 (41%)	<0.0001
Arterial hypertension, n (%)	136/139 (98%)	456/473 (96%)	0.4
Diabetes mellitus, n (%)	75/139 (54%)	188/473 (40%)	0.003
CHD/ PAD, n (%)	94/139 (68%)	196/473 (41%)	<0.0001
CHF, n (%)	128/139 (92%)	22/473 (5%)	<0.0001
Type of AF n (%) · paroxysmal · Persistent · permanent	· 50/139 (36%) · 49/139 (35%) · 40/139 (29%)	· 194/473 (41%) · 145/473 (31%) · 134/473 (28%)	0.49 0.49 0.48
CHA2DS2-VASc-Score, median (IQR)	5 (4-6)	4 (3-5)	<0.0001

 

 

 

 

 

 

 

  











Procedural data and intra-hospital Outcome

Variable, n (%)	LV-EF < 50	LV-EF ≥ 50	RR (95%CI)	p
Follow-up duration in months	20 (4-40)	18.5 (3-50)	-	0.13
Stroke	1/139 (0.7%)	9/473 (1.9%)	0.37 (0.04-2.95)	0.33
TIA	3/139 (2.2%)	5/473 (1.1%)	2.04 (0.49-8.43)	0.31
Systemic embolism	1/139 (0.7%)	2/473 (0.4%)	1.7 (0.15-18.62)	0.66