Background: Percutaneous left atrial appendage occlusion (LAAO) devices are a therapeutic alternative used for the prevention of stroke in patients with atrial fibrillation (AF). Population with chronic kidney disease (CKD) are at high risk of procedural complications after transcatheter intervention; however, there is no meta-analysis on procedural success in CKD vs. non-CKD population receiving LAAO interventions.

Aims: To perform a systematic review and meta-analysis of the real-world evidence (RWE) data on the procedure success of LAAO in CKD population compared to the non-CKD population.

Methods: PubMed, EMBASE, and Cochrane database were searched, from inception to January 2021, for published RWE studies reporting the procedural success rate for LAAO device implantation in patients with or without CKD. Two researchers independently screened search results and extracted data for study details (design, follow-up, assessment etc.), outcome results (procedure success rate), and conclusion. The quality of the included studies was assessed using Newcastle-Ottawa Scale (NOS) and random-effect model was used for meta-analysis.

Results: Of 65 articles identified, four studies (2 from Germany, 1 from China, and 1 multinational) comprising 678 CKD and 978 non-CKD patents receiving LAAO fulfilled the inclusion criteria. The majority (n= 3) of the studies were of high quality. CKD was defined as an eGFR <60 ml/min per 1.73 m2 across studies. Three studies reported procedural success rate as successful implantation and absence of significant residual leak (≥5 mm). The mean age was above 70 years and Aamplatzer cardiac plug was used in most of the LAAO procedures (68%, n=1122), across studies. The meta-analysis showed a similar procedural success rate for LAAO procedure (CKD=98.4 and non-CKD=96.9) with a pooled risk difference of 0.01 [(95%CI: 0.00-0.03), p=0.07].

Study characteristics

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Meta-analysis of the LAAO procedure success in CKD vs non-CKD population

 

Conclusions: The procedural success rate of LAAO did not differ between the CKD and non-CKD patients. LAAO demonstrated similar real-word procedural safety for patients with and without CKD.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/procedural-success-of-left-atrial-appendage-occlusion-device-in-patients-with-chronic-kidney-disease-meta-analysis-of-real-world-data/