Patients with paroxysmal atrial fibrillation undergoing left atrial appendage closure

There is limited evidence regarding outcome in patients with paroxysmal vs. persistent atrial fibrillation (AF) undergoing left atrial appendage closure (LAAC).

A retrospective analysis from a multicentre registry including consecutive patients undergoing LAAC was performed, investigating in baseline and outcome differences between patients with paroxysmal and persistent AF. Paroxysmal AF was defined as periprocedural heart rhythm free from atrial arrhythmia. Major short-term complications were defined as any complication necessitating an invasive intervention, or death. Differences in baseline characteristics were adjusted by inverse probability weighting.

A total of 510 patients from 9 centres were included. Median age was 76 (interquartile range 70-79) years and 35.5% were female. Patients with paroxysmal AF were younger (median 73 vs. 76 years, p<0.001), had more often terminal kidney disease requiring haemodialysis (4.1% vs. 0.6%, p=0.008) but a lower prevalence of reduced left-ventricular ejection fraction (19.3% vs. 28.0%, p=0.040), significant mitral regurgitation (2.9% vs. 7.4%, p=0.047), and significant tricuspid regurgitation (2.8% vs. 8.3%, p=0.003). Furthermore, nt-proBNP levels were lower in patients with paroxysmal AF (median 339 vs. 1380 pg/mL, p<0.001). There were no significant differences in CHA2DS2-VASc (median 4 vs. 5, p=0.165) and HAS-BLED scores (median 3 vs. 3, p=0.370) between both groups.

Major procedural complications occurred in 7.0% in patients with paroxysmal AF and in 4.7% in patients with persistent AF (p=0.306). Five-year survival was similar between groups with no trend favouring any subgroup (unadjusted survival 88.9% vs. 82.6%, p=0.070). Adjusted five-year survival was similar between groups (hazard ratio for paroxysmal AF: 0.636, 95% confidence interval 0.375-1.076, p=0.092, Figure).

While significant differences in baseline characteristics persist, short- and long-term complications were similar in patients with paroxysmal vs. persistent AF undergoing LAAC.

5-year survival