In-hospital outcomes of left atrial appendage (LAA) occlusion among cancer patients with atrial fibrillation: a nationwide US study

AF is frequently observed in patients with cancer, driven by mutual comorbidities. The risk of thromboembolic and hemorrhagic events escalates significantly for individuals with both AF and cancer. Impediments can hinder the utilization of anticoagulants among patients with malignancy: drug interactions with chemotherapy, renal dysfunction, drug intolerance, and increased bleeding risk. LAA occlusion (LAAO) is an effective and safe non-pharmacological approach to prevent thromboembolic complications when anticoagulants are not suitable. Cancer patients were generally excluded from the original LAAO trials, and current efficacy and safety of LAAO in patients with cancer is unknown.

Using the National Inpatient Sample (NIS) database, patients who underwent LAAO in the US between 2016 and 2019 were identified using ICD10 codes. Sociodemographic, clinical data, in-hospital procedures and outcomes and length-of-stay (LOS) were collected. Baseline characteristics and in-hospital outcomes were compared between patients with and without cancer.

An estimated total of 61,395 hospitalizations for LAAO were performed during the study period. 61% of patients were male and 2.1% had a cancer diagnosis. Older age, male gender, prior stroke, hypertrophic cardiomyopathy and anemia were more prevalent in the cancer group with 825(57%) having a solid malignancy, and hematologic malignancy in 610(43%).

In-hospital complications occurred in 3520 LAAO patients (5.7%). Patients with cancer diagnosis had a higher rates of total in-hospital complications (9% vs 5.7%;p<0.001), driven by acute kidney injury(3.2% vs 1.8%;p=0.002) and infectious complications (4.3% vs. 2.4%;p<0.001). No significant differences were observed in cardiac, respiratory complications, periprocedural stroke and in-hospital mortality. Average LOS was longer in cancer patients.

LAAO in cancer patients is associated with increased kidney and infectious complications, but not with cardiac complications or increased in-hospital mortality in a nationwide, all-comer registry. These findings suggest LAAO as a safe treatment option for managing embolic prevention in cancer patients.