Outcomes of Left Atrial Appendage Closure in Hemodialysis Patients With Atrial Fibrillation: The OCEAN-LAAC Registry

Background: Left atrial appendage closure (LAAC) has demonstrated favorable outcomes as an alternative to permanent anticoagulation in patients with nonvalvular atrial fibrillation (NVAF). In hemodialysis (HD) patients with NVAF, anticoagulation increases bleeding complications, with inconsistent benefits in stroke prevention. Objectives: This study aimed to clarify the benefit of LAAC for HD patients. Methods: Consecutive patients who underwent LAAC, as extracted from the Japanese multicenter registry, were eligible. When comparing HD and non-HD patients, perioperative events, including LAAC procedure success rates and the incidence of death, bleeding events, and ischemic stroke events, were analyzed. Results: Among 1,464 patients (mean age 77.1 ± 7.6 years, mean CHA₂DS₂-VASc score 4.9 ± 1.5, mean HAS-BLED score 3.1 ± 1.0), 172 were HD patients. The HD group had higher HAS-BLED scores, whereas more patients in the non-HD group had a history of Bleeding Academic Research Consortium type 3 bleeding. Device implantation success was 97.3% (95% CI: 96.3%-98.0%) (HD group; 97.1% [167 of 172], non-HD group; 97.3% [1,257 of 1,292]; P = 0.88). There were no in-hospital deaths, and perioperative complications were rare and did not differ between the 2 groups. The median follow-up period was 367 days (Q1-Q3: 242-422 days). The ischemic stroke rate following LAAC in the HD group was 1.1% (95% CI: 0.3%-1.9%) per 100 patient-years, comparable to the non-HD group. Conclusions: LAAC is feasible for HD patients and achieves results comparable to those in non-HD patients. Further research is necessary to determine the effectiveness of LAAC in preventing stroke in HD patients.