Long-Term Outcomes of Minimalist Left Atrial Appendage Occlusion Guided Only by Periprocedural Imaging.

BACKGROUND

Pre- and post-procedural imaging in left atrial appendage occlusion (LAAO) adds to patient inconvenience and risks and may not materially influence outcomes. A more focused approach involving only peri-procedural imaging may suffice.

METHODS AND

RESULTS

Data from patients who had LAAO at our centre between 2009 and 2024 were examined. Those with pre- and post-procedure imaging studies were excluded. Efficacy outcomes including procedural success and periprocedural complication were recorded. Long-term outcomes comprising cerebrovascular events, major bleeding, cardiovascular and all-cause death were retrieved through review of regional and national digital health records. 247 patients met the analysis criteria. The median CHA2DS2-VASc and HAS-BLED scores were 4 [interquartile range (IQR) 3-5)] and 3 (IQR 3-4) respectively. Successful closure of the left atrial appendage was achieved in 245 (99.2%) patients. Periprocedural death and complications occurred in 0.4% and 2.4% of patients respectively. Follow-up was obtained for 1155 patient-years (median follow-up time 6.8 years). Clinical stroke occurred in 6.9% of patients (1.55 per 100 patient-years)-a 67% reduction compared to that expected from the CHA2DS2-VASc score. 11.4% of patients suffered from major bleeding (2.56 per 100 patient-years)-a 55% reduction compared to that expected from the HAS-BLED score. 40.8% (8.65 per 100 patient-years) of patients died during follow-up. Patients suffering from cerebrovascular events had higher CHA2DS2-VASc (p = 0.048) and HAS-BLED scores (p = 0.045).

CONCLUSION

A minimalistic approach in LAAO using only periprocedural imaging guidance is feasible and safe, with an excellent success rate and a resultant reduction in cerebrovascular events in long-term.