Association of chronic kidney disease and end-stage renal disease with procedural complications and in-hospital outcomes from left atrial appendage occlusion device implantation in patients with atrial fibrillation: Insights from the national inpatient sample of 36,065 procedures

Muhammad Bilal Munir, Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California.
Muhammad Zia Khan, Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia.
Douglas Darden, Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California.
Marin Nishimura, Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California.
Sai Vanam, Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California.
Deepak Kumar Pasupula, Division of Cardiology, MercyOne North Iowa Medical Center, Mason City, Iowa.
Zain Ul Asad, Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Abhishek Bhagat, Division of Cardiology, University of Arizona College of Medicine, Phoenix, Arizona.
Salman Zahid, Rochester Regional HealthFollow
Mohammed Osman, Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia.
Sudarshan Balla, Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia.
Frederick T. Han, Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California.
Ryan Reeves, Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California.
Jonathan C. Hsu, Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California.

Department

Medicine

Document Type

Article

Publication Title

Heart Rhythm O2

Abstract

Background: Left atrial appendage occlusion (LAAO) has emerged as an alternative strategy to oral anticoagulation for mitigating ischemic stroke risk in selected patients with atrial fibrillation (AF), but safety data in patients with significant kidney disease are limited. Objective: To determine the association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with procedural complications and in-hospital outcomes after LAAO in AF patients. Methods: Data were extracted from National Inpatient Sample for calendar years 2015-2018. Watchman implantations were identified on the basis of International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes of 37.90 and 02L73DK. The outcomes assessed in our study included complications, inpatient mortality, and resource utilization with LAAO. Results: A total of 36,065 Watchman recipients were included in the final analysis. CKD (9.8%, n = 3545) and ESRD (3%, n = 1155) were associated with a higher prevalence of major complications and mortality in crude analysis compared to no CKD. After multivariate adjustment for potential confounders, CKD was associated with length of stay (LOS) >1 day (adjusted odds ratio [aOR] 1.355; 95% confidence interval [CI] 1.234-1.488), median cost >$24,663 (aOR 1.267; 95% CI 1.176-1.365), and acute kidney injury (aOR 4.134; 95% CI 3.536-4.833), while ESRD was associated with in-patient mortality (aOR 7.156; 95% CI 3.294-15.544). Conclusion: The prevalence of CKD and ESRD was approximately 13% in AF patients undergoing Watchman LAAO implantations. CKD was independently associated with prolonged LOS, higher hospitalization costs, and acute kidney injury, while ESRD was independently associated with in-patient mortality.

First Page

472

Last Page

479

DOI

10.1016/j.hroo.2021.08.002

Volume

2

Issue

5

Publication Date

8-21-2021

PubMed ID

34667962

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