Early and Late Readmission after Left Atrial Appendage Closure

Percutaneous left atrial appendage closure (LAAC) represents an effective alternative for patients with atrial fibrillation and anticoagulation contraindication. This study looked at incidence, predictors and clinical impact of post procedural early (≤30 days) and late (31–365 days) readmission.

The study included 1,419 consecutive patients undergoing LAAC between 2009 and 2022 from nine hospitals across Canada and Europe. Mean patient age was 75.9 ± 8.3, and 36.8% were women. Mean CHA₂DS₂-VASc score was 4.33 ± 1.6 and mean HAS-BLED score was 3.61 ± 1.07. The main indication for this procedure was oral anticoagulation contraindication: 42.7% absolute (intracranial or major bleeding) and 46.3% relative (anemia or digestive bleeding); only 11.1% did not present a formal contraindication. Nine patients died during procedure or before discharge.

The Amplatzer (Cardiac Plug or Amulet) was the mostly used (68.6% of cases), followed by the Watchman FLX or 2.5 (used in 24.6%). Success rate was 99.4% and complete occlusion was achieved in 93.4% of cases. At discharge, 24.1% of patients received oral anticoagulation (OAC), 26.7% SAPT, 40.7% DAPT and 4.9% OAC + SAPT.

During the first year, 257 patients (18.1%) were readmitted: 46 (3.2%) early and 211 (14.9%) late, most frequently because of bleeding (24.5%), mainly digestive (15.1%) and intracranial (2.3%). Cardiac causes accounted for 29.2% of readmissions, including device complications (6%) and cardiac failure (20.6%).

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Among the independent predictors of readmission were a history of gastrointestinal bleeding (OR 2.65; CI95% 1.23–5.71) for early readmission and low body mass index, diabetes, chronic kidney failure and prior heart failure late readmission. Neurological events included stroke (2.2% before 30 days; 5.2% before one year), TIA (4.7%) and intracranial bleeding (2.2% early; 2.4% late).

DAPT at discharge was more frequent among patients who were later rehospitalized (48.6% vs. 38.9%; p = 0.004). Though 86% reduced antithrombotic therapy within the first six months, DAPT at discharge was associated to higher risk of overall readmission (HR 1.40; CI95% 1.08–1.80). Instead, OAC at discharge was not associated to higher risk of readmission. At 2 years, there were 274 deaths (19.3%), and both early and late readmission (HR 2.12; CI95% 1.22–3.70/ HR 1.75; CI95% 1.41–2.17 respectively) were linked to increased mortality.

Conclusion

One every five patients undergoing left atrial appendage closure will be rehospitalized within one year after procedure, mainly for bleeding or cardiac failure, events associated with increased 2-year mortality at. Adequate patient selection, comprehensive comorbidity assessment and individualized antithrombotic therapy are vital for clinical outcome optimization after LAAC. 

Original Title: Early and Late Hospital Readmissions After Percutaneous Left Atrial Appendage Closure.

Authors: Kim Hoang Trinh, Jorge Nuche, Ignacio Cruz-González, et al.

Original Title: Revista Española de Cardiología, Volumen 78, Número 4, 2025, páginas 327–337.