Comparison in Patients < 75 Years of Age - vs - Those > 75 Years on One-Year-Events with Atrial Fibrillation and Left Atrial Appendage Occluder (From the Prospective Multicenter German LAARGE Registry).

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Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation therapy in patients with non-valvular atrial fibrillation for the prevention of embolic stroke and systemic embolism. Although elderly patients (>75 years) have both higher ischemic and bleeding risk as compared to younger patients, they benefit from optimal anticoagulation. The sub-analysis aimed to assess the indications, the safety, efficacy, and 1-year outcomes of interventional LAAC in elderly patients (≥ 75 years) compared to younger (< 75 years) patients in clinical practice. We analysed data from the prospective Left-Atrium-Appendage Occluder Registry Germany (LAARGE). A total of 638 patients were included in the registry, 402 (63%) were aged ≥ 75 years. Compared to younger subjects, patients aged ≥75 were more likely to have higher CHA2DS2-VASC and HAS-BLED scores. Procedural success rate was high und similar in both groups (97.6%). Periprocedural adverse events were not statistically significant among groups (11.9% in <75 years vs 12.9% in ≥75 years; p=0.80). At one year follow-up, all-cause mortality was higher in patients aged ≥75 compared to younger group (13.0% vs.7.8 %,p= 0.04), mainly due to non-cardiovascular causes (10.6% vs. 6.0%). No significant differences in major bleeding, stroke, systemic embolism were observed. In conclusion, LAAC is feasible and safe in patients with AF at high stroke risk and with contraindications for OAC and should be considered as candidates for LAA closure. Elderly patients often present these characteristics and could benefit from this novel therapy.


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