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June 27, 2026EP EuropaceOpen Access

High thromboembolic risk in LAAC is linked to ~10% lower 5-year survival despite similar short-term complications.

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Why the study?

Does left atrial appendage closure have similar safety and survival outcomes in atrial fibrillation patients with high thromboembolic risk compared to lower risk patients?

Population

549 consecutive patients with atrial fibrillation undergoing left atrial appendage closure from a…

Comparison

Left atrial appendage closure in patients with… vs Left atrial appendage closure in remaining…

Design

Cohort

Follow-up

30 days and 5 years

Key result

In AF patients undergoing LAAC, high thromboembolic risk was associated with similar major short-term complications (5.7% vs 4.0%, p=0.417) but reduced 5-year survival (73.1% vs 83.5%, p=0.002).

Authors

DZD ZweikerGTG TothGSG Stix

Discussion

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Overview

High-risk patients face reduced survival warranting closer monitoring; leaves open whether targeted interventions improve outcomes in trials.

Key Points

  • This analysis aims to compare outcomes of high thromboembolic risk patients with others undergoing left atrial appendage closure.
  • Retrospective analysis of a multicenter registry including 549 patients undergoing left atrial appendage closure.
  • Defined high thromboembolic risk as a CHA2DS2-VA score greater than 4.
  • Examined baseline characteristics and outcomes, focusing on complications and survival rates.
  • Major complications were similar between high-risk (5.7%) and remaining patients (4.0%) with p=0.417.
  • 30-day survival was better in high-risk group (100%) compared to others (92.2%) with p=0.021.
  • 5-year survival was significantly lower in the high-risk patients (73.1%) compared to the others (83.5%) with p=0.002.

Study Design

Type

Cohort (n=549)

Multicenter

Yes

Structured PICO

Does left atrial appendage closure have similar safety and survival outcomes in atrial fibrillation patients with high thromboembolic risk compared to lower risk patients?

P
Population
549 patients with atrial fibrillation undergoing left atrial appendage closure, followed for up to 5 years.
E
Exposure
Left atrial appendage closure in patients with high thromboembolic risk (defined as CHA2DS2-VA score > 4)
C
Comparator
Left atrial appendage closure in remaining patients (CHA2DS2-VA score <= 4)
O
Outcome
Major short-term complications (defined as any complication necessitating an invasive intervention, or death) and survival (30-day and 5-year)hard clinical

Main Result

Absolute Event Rate: 5.7% vs 4%

p-value: p=0.417

LAAC in atrial fibrillation patients with high thromboembolic risk has similar periprocedural safety to lower-risk patients, though long-term survival is worse, likely reflecting their higher baseline comorbidity burden.

Cite This Study

Zweiker et al. (2026) conducted a cohort in Atrial fibrillation (n=549). High thromboembolic risk (CHA2DS2-VA score > 4) vs. Remaining patients (CHA2DS2-VA score ≤ 4) was evaluated on Major short-term complications (any complication necessitating an invasive intervention, or death) (p=0.417). In AF patients undergoing LAAC, high thromboembolic risk was associated with similar major short-term complications (5.7% vs 4.0%, p=0.417) but reduced 5-year survival (73.1% vs 83.5%, p=0.002).

synapsesocial.com/papers/6a3f97e8125782b61d865adahttps://doi.org/10.1093/europace/euag105.389
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