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      Left atrial appendage closure outcomes in relation to atrial fibrillation patterns: a comprehensive analysis

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          Abstract

          Objective

          The effect of atrial fibrillation (AF) patterns on outcomes remains controversial. This study aims to evaluate the influence of AF type on the risk of cardiocerebrovascular events after left atrial appendage closure (LAAC) at long-term follow-up.

          Methods

          AF was categorized as paroxysmal AF (PAF) and non-PAF (NPAF). The baseline characteristics, procedural data, peri-procedural complications, and long-term outcomes between patients with PAF and NPAF after LAAC were compared.

          Results

          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 chronic kidney disease (CKD) compared with the PAF group. The procedural data and peri-procedural 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 the CHA 2DS 2-VASc and HAS-BLED scores, respectively, in patients who underwent LAAC, regardless of the AF type. NPAF patients were associated with a higher risk of all-cause mortality, non-cardiovascular mortality, and combined efficacy endpoints. This association disappeared after propensity score matching (PSM) analysis.

          Conclusions

          The risk of thromboembolism and major bleeding was lower in patients who underwent LAAC, regardless of the 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.

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          Most cited references25

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          OUP accepted manuscript

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            2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.

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              Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study.

              The impact of some risk factors for stroke and bleeding, and the value of stroke and bleeding risk scores, in atrial fibrillation (AF), has been debated, as clinical trial cohorts have not adequately tested these. Our objective was to investigate risk factors for stroke and bleeding in AF, and application of the new CHA(2)DS(2)-VASc and HAS-BLED schemes for stroke and bleeding risk assessments, respectively. We used the Swedish Atrial Fibrillation cohort study, a nationwide cohort study of 182 678 subjects with a diagnosis of AF at any Swedish hospital between 1 July 2005 and 31 December 2008, who were prospectively followed for an average of 1.5 years (260 000 years at risk). With the use of the National Swedish Drug Registry, all patients who used an oral anticoagulant anytime during follow-up were identified. Most of the analyses were made on a subset of 90 490 patients who never used anticoagulants. Risk factors for stroke, the composite thromboembolism endpoint (stroke, TIA, or systemic embolism), and bleeding, and the performance of published stroke and bleeding risk stratification schemes were investigated. On multivariable analysis, significant associations were found between the following 'new' risk factors and thromboembolic events; peripheral artery disease [hazard ratio (HR) 1.22 (95% CI 1.12-1.32)], 'vascular disease' [HR 1.14 (1.06-1.23)], prior myocardial infarction [HR 1.09 (1.03-1.15)], and female gender [HR 1.17 (1.11-1.22)]. Previous embolic events, intracranial haemorrhage (ICH), hypertension, diabetes, and renal failure were other independent predictors of the composite thromboembolism endpoint, while thyroid disease (or hyperthyroidism) was not an independent stroke risk factor. C-statistics for the composite thromboembolic endpoint with the CHADS(2) and CHA(2)DS(2)-VASc schemes were 0.66 (0.65-0.66) and 0.67 (0.67-0.68), respectively. On multivariable analysis, age, prior ischaemic stroke or thromboembolism, prior major bleeding events, and hypertension were significant predictors of ICH and major bleeding. Heart failure, diabetes, renal failure, liver disease, anaemia or platelet/coagulation defect, alcohol abuse, and cancer were other significant predictors for major bleeding, but not ICH. The ability for predicting ICH and major bleeding with both bleeding risk schemes (HEMORR(2)HAGES, HAS-BLED) were similar, with c-statistics of ~0.6. Several independent risk factors (prior ICH, myocardial infarction, vascular disease, and renal failure) predict ischaemic stroke and/or the composite thromboembolism endpoint in AF, but thyroid disease (or hyperthyroidism) was not an independent risk factor for stroke. There is a better performance for CHA(2)DS(2)-VASc over CHADS(2) schemes for the composite thromboembolism endpoint. While both tested bleeding risk schemes have similar predictive value, the HAS-BLED score has the advantage of simplicity.
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                Author and article information

                Contributors
                Role: Role: Role: Role: Role: Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/1490791/overviewRole: Role: Role: Role: Role:
                Role: Role:
                Role: Role: Role:
                Role: Role: Role:
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                Journal
                Front Cardiovasc Med
                Front Cardiovasc Med
                Front. Cardiovasc. Med.
                Frontiers in Cardiovascular Medicine
                Frontiers Media S.A.
                2297-055X
                22 May 2024
                2024
                : 11
                : 1389811
                Affiliations
                [ 1 ]Cardiovascular Center, Chengdu Shuangnan Hospital , Chengdu, China
                [ 2 ]Heart Center, Zhengzhou Ninth People’s Hospital , Zhengzhou, China
                [ 3 ]Department of Cardiology, Helmut-G.-Walther-Klinikum , Lichtenfels, Germany
                [ 4 ]Clinic for General Internal Medicine and Cardiology, Catholic Medical Center Koblenz-Montabaur , Koblenz, Germany
                [ 5 ]Cardiovascular Division, Department of Medicine, University of Minnesota Medical School , Minneapolis, MN, United States
                Author notes

                Edited by: Konstantinos Athanasios Gatzoulis, National and Kapodistrian University of Athens, Greece

                Reviewed by: Carlo Lavalle, Sapienza University of Rome, Italy

                Vincenzo Mirco La Fazia, Texas Cardiac Arrhythmia Institute, United States

                Stergios Soulaidopoulos, Aristotle University of Thessaloniki, Greece

                [* ] Correspondence: Mingzhong Zhao snmzzhao@ 123456163.com Jiangtao Yu j.yu@ 123456kk-km.de
                Article
                10.3389/fcvm.2024.1389811
                11150762
                38841258
                3f01ef99-9d7f-4a29-a951-b43ae68744a9
                © 2024 Zhao, Yu, Hou, Post, Zhang, Xu, Herold and Walsleben.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 22 February 2024
                : 29 April 2024
                Page count
                Figures: 6, Tables: 5, Equations: 0, References: 25, Pages: 0, Words: 0
                Funding
                The authors declare that no financial support was received for the research, authorship, and/or publication of this article.
                Categories
                Cardiovascular Medicine
                Original Research
                Custom metadata
                Cardiac Rhythmology

                atrial fibrillation,atrial fibrillation pattern,left atrial appendage closure,outcomes,thromboembolism

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