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Real-world experience with percutaneous left atrial appendage closure in patients with atrial fibrillation in China (English version)

Background: This study aimed to display the real-world application of percutaneous left atrial appendage closure (LAAC) in patients with atrial fibrillation (AF) through analyzing the clinical data and operation information. Materials and Methods: AF patients who had received LAAC were selected from the database of China AF Center from November 2018 to November 2019. The clinical characteristics, surgical parameters, surgical complications, and end-of-operation rhythm were collected and analyzed. Comparisons of clinical characteristics, rate of success, and complications were performed between the simple LAAC group and the LACC combined with catheter ablation group. The study was approved by the Expert Committee of the Chinese AF Center in 2019. The study trial was registered with the Chinese Clinical Trial Registry (registration No. ChiCTR1900021250) on February 3, 2019. Results: A total of 2001 eligible patients from 175 hospitals were included in the final analysis in this real-world study, with 1178 males (58.9%). The mean age was 69.4 years (29–91 years). The proportion of paroxysmal AF was 44.6% (892 patients). The mean of CHA2DS2-VASC score congestive heart failure, hypertension, age ≥75 [doubled], diabetes mellitus, prior stroke or transient ischemic attack [doubled], vascular disease, age 65–74, female) and HAS-BLED score (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly [>65 years], and drugs/alcohol concomitantly) was 3.7 and 3.9, respectively. The main occluder was Watchman (1,276/2,001, 63.8%), surgical complications were 9.5% (190 patients), residual peri-device flow was 5.1% (102 patients), success rate was 98.9% (1979 patients), and final sinus rhythm was 63.4% (1269 patients). Compared with the simple LAAC group (1,075 patients, 53.7%), the LACC combined with catheter ablation group (926 patients, 46.3%) was younger, with a higher proportion of paroxysmal AF (624 [67.4%] vs. 268 [24.9%], P < 0.001), higher CHA2DS2-VASC score (4.0 ± 1.5 vs. 3.7 ± 1.4, P < 0.001), lower HAS-BLED score (3.6 ± 1.6 vs. 3.9 ± 1.2, P < 0.001), lower residual peri-device flow (26 [2.8%] vs. 76 [7.1%], P < 0.001), and higher sinus rhythm after surgery (96.7% vs. 34.8%, P < 0.001). However, the rates of success (99.2% vs. 98.7%, P = 0.275) and complications (9.7% vs. 9.3%, P = 0.670) were similar. Conclusion: There is a high success rate and low incidence of severe complications in the real-world use of LAAC in patients with AF. LAAC combined with catheter ablation is also safe and effective due to lower complications and higher proportion of sinus rhythm.