Background: Impaired renal function increases the bleeding risk, leading to a conservative prescription and\nfrequent discontinuation of oral anticoagulation in atrial fibrillation patients with chronic kidney disease (CKD).\nInterventional left atrial appendage closure (LAAC) might be an alternative therapeutic strategy for these patients.\nMethods: We aimed to prospectively assess cerebrovascular (CE) and bleeding events, as well as peri-procedural\nand long-term complications in a cohort of consecutive patients undergoing interventional LAAC using the\nWATCHMANâ?¢ device, with focus on CKD patients.\nResults: One hundred and eighty-nine consecutive patients undergoing interventional LAAC were included in this\nanalysis; 171 (90.5%) patients had a reduced estimated glomerular filtration rate (eGFR; patients for each CKD stage: II =\n66; IIIa = 32; IIIb = 43; IV = 18; V = 12). During a follow-up of 310 patient years three (1.0%) patients suffered a CE (two\nstrokes, one transitory ischemic attack) and five (1.6%) other ones a bleeding complication. The observed stroke rate\nwas more than two-thirds and the bleeding risk more than half lower than expected. Device related thrombi (DRT)\nwere detected in twelve (6.5%) patients; women had significantly more DRT than men (12.5% vs. 2.6%; p = 0.009).\nPatients with an eGFR< 30ml/min/1.73m^2 showed a trend to a higher DRT rate as compared to the opposite group\n(13.3% vs. 5.1%; p = 0.10). Thrombus resolved with temporary oral anticoagulation therapy in ten patients without\nsequelae; thrombus consolidation was confirmed by serial TEE controls in the remaining two patients.\nConclusions: Atrial fibrillation patients with CKD have low CE and bleeding rates after LAAC with the WATCHMANâ?¢\ndevice. DRT risk is higher in female and patients with severe CKD. More frequent post-interventional TEE controls might\nbe justified for early DRT detection and safe management of patients at high DRT risk.
Loading....