Incidence and nationwide estimates of spontaneous intracerebral hemorrhage in patients with atrial fibrillation eligible for left atrial appendage closure. Dijon Stroke Registry

BACKGROUND: With aging population, an increasing proportion of spontaneous intracerebral hemorrhage (ICH) occur in patients receiving anticoagulation for atrial fibrillation (AF). Left atrial appendage (LAA) closure has emerged as an alternative strategy. In the absence of population-level data, this study aimed to estimate the incidence of ICH among patients with AF who could potentially be eligible for LAA closure and to extrapolate these findings to the national level. METHODS: All cases of ICH were prospectively identified from the population-based Dijon Stroke Registry, France (2013-2022). Eligibility for LAA closure was assessed among patients with AF after excluding those who died within 30 days, had another indication for long-term anticoagulation, or a CHA₂DS₂-VA score <2. Annual incidence rates were calculated by age groups and sex. Nationwide estimates were derived by standardizing age- and sex-specific incidence to the French population. RESULTS: Among 369 ICH cases, 104 (28.2%) occurred in patients with AF, of whom 36 were considered eligible for LAA closure (mean age: 80.7 ±11.2 years; 52.8% women). Crude incidence of eligible ICH was 2.3 per 100,000 person-years (95% CI, 1.6-3.2). After standardization, the estimated number of eligible patients in France was 1,732 in 2022, projected to reach 2,354 by 2035 and 2,780 by 2050. CONCLUSIONS: Approximately one in four ICH cases occurs in patients with AF, but only a small proportion would be theoretically eligible for LAA closure. These population-based estimates provide essential data to inform healthcare planning and guide future clinical trials evaluating LAA closure in this high-risk population.