Left Atrial Appendage Closure Outcomes in Relation to Atrial Fibrillation Patterns: A Comprehensive Analysis Provisionally Accepted

Mingzhong Zhao^1* Jiangtao Yu^2* Cody R Hou³ Felix Post² Lei Zhang¹ Yuhui Xu¹ Nora Herold² Jens Walsleben²

• ¹Cardiovascular Center, Chengdu Shuangnan Hospital, China
• ²Catholic Medical Center Koblenz-Montabaur, Germany
• ³Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, United States

Objective: The effect of atrial fibrillation (AF) patterns on outcomes remains controversial. We evaluated the influence of AF type on the risk of cardio-cerebrovascular events after left atrial appendage closure (LAAC) at long-term follow-up.Methods: AF was categorized as paroxysmal AF (PAF) and non-PAF (NPAF).Baseline characteristics, procedural data, peri-procedural complications, and long-term outcomes were compared between patients with PAF versus NPAF after LAAC.We analyzed 410 AF patients (mean age 74.8 ± 8.2 years; 271 male; 144 with PAF, 266 NPAF). The NPAF group tended to be older (≥75 years), male, and have CKD compared with the PAF group. Procedural data and periprocedural complications were comparable. During 2.2 ± 1.5 years of follow-up, the incidences of thromboembolism, major bleeding, and device-related thrombus (DRT) did not differ between the two groups. The observed risk of thromboembolism and major bleeding was significantly lower than the estimated risk based on CHA2DS2-VASc and HAS-BLED scores, respectively, in patients who underwent LAAC, regardless of AF type. NPAF patients were associated with higher risk of all-cause mortality, non-cardiovascular mortality and combined efficacy endpoints; this association disappeared after propensity score matching (PSM) analysis.The risk of thromboembolism and major bleeding was lower in patients who underwent LAAC, regardless of AF type. Although NPAF often coexists with multiple risk factors, it was not associated with worse long-term outcomes after LAAC when compared with PAF.