Atrial appendage closure in patients with atrial fibrillation undergoing renal replacement therapy

Introduction: left atrial appendage occlusion (LAAO) is a therapeutic alternative in patients with nonvalvular atrial fibrillation (NVAF) when anticoagulation is contraindicated.In patients with NVAF on renal replacement therapy, the embolic risk is accompanied by a very high risk of bleeding.Anticoagulant therapy has not shown an adequate risk-benefit relationship.Objective: to describe the population of patients with atrial fibrillation on renal replacement therapy who undergo percutaneous atrial appendage occlusion, and the immediate results of the intervention.Method: this was a retrospective, multicenter, descriptive study of patients with NVAF and chronic kidney disease on renal replacement therapy who underwent LAAO from 2017 to 2022.Results: this series of 25 patients had the following characteristics: average age: 68.8 years; 68% were men, 100% had hypertension, 52% had type 2 diabetes mellitus, and 36% had coronary disease.The average CHA2DS2-VASc score for measuring embolic risk was 4 points.The average systolic function measured by left ventricular ejection fraction (LVEF) was 55%.A total of 48% were on anticoagulation.As far as the devices used, 76% were WATCHMAN and 24% were Amulet devices.The procedure was successful in 96%.There were four non-serious complications.There were no intervention-related ischemic cerebrovascular events or deaths.Conclusion: LAAO in patients on renal replacement therapy has proven to be an effective and safe alternative, with a low rate of complications and a favorable initial follow-up.