Left atrial appendage closure in patients with cancer

Atrial fibrillation (AF) is up to four times more prevalent in cancer patients than in the general population. The main contributing factors include direct cancer-related damage, the toxicity of oncological treatments, and the fact that cardiovascular disease and cancer share numerous risk factors. Additionally, the oncological population has a higher risk of both thrombosis and bleeding, making anticoagulation management particularly challenging. Left atrial appendage closure (LAAC) has been shown to be a valid technique for discontinuing anticoagulation in AF patients without increasing the risk of embolic events associated with AF. However, current data on LAAC in oncological patients remain limited, with most evidence derived from sub-analyses of pivotal safety studies.

The aim of this study was to assess the safety of LAAC in cancer patients. Additionally, a descriptive analysis was conducted to evaluate the most common cancer types among patients undergoing LAAC in our centre and their association with bleeding events.

A retrospective study was conducted, including the most recent 62 patients in our hospital who had undergone LAAC and had a prior cancer diagnosis. Baseline characteristics, the main indication for LAAC, complication rates, and one-year mortality were analysed.

Eighty per cent of patients were male, and the mean age at the time of the procedure was 77.5 years. Figure 1 illustrates the distribution of cancer types in the study population. The cancer types most frequently associated with bleeding were urothelial cancer, followed by prostate adenocarcinoma and haematological malignancies. The primary indication for LAAC was prior bleeding (58%, 36 patients), high haemorrhagic risk or patient preference to discontinue anticoagulation (30%, 19 patients); the remaining 11% underwent the procedure due to a history of ischaemic stroke.

The overall complication rate was 9% (6 patients): three patients experienced minor complications at the puncture site, one developed pericarditis post-procedure, one suffered cardiac tamponade requiring pericardiocentesis, and one had transient ST-segment elevation with a normal coronary angiogram. The one-year survival rate was 93%, while the two-year survival rate was 83%.

LAAC is a safe and effective procedure in cancer patients with AF, allowing for anticoagulation discontinuation without increasing embolic risk. The complication rate observed in this study was comparable to that reported in the literature, with most events being minor. Urothelial and haematological malignancies were associated with a higher risk of bleeding, emphasising the need for careful patient selection. One-year survival rates suggest that the procedure does not adversely impact oncological outcomes. Further prospective studies are warranted to validate these findings and optimise patient selection criteria.

Classification of cancer types