SPC365

Closing the Gap: Left Atrial Appendage Occlusion in Atrial Fibrillation Patients with Cancer

Session: SESSÃO DE COMUNICAÇÕES ORAIS 10 – DOENÇA CARDIOVASCULAR EM DOENTES ONCOLÓGICOS E ANTICOAGULAÇÃO
Speaker: Sofia Esteves

Congress: CPC 2025
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.6 Cardio-Oncology
Session Type: Comunicações Orais
FP Number: ---
Authors: Sofia Esteves; Miguel Nobre Menezes; Catarina Santos Gregório; Ana Abrantes; Ana Rita Francisco; Catarina Simões Oliveira; Tiago Rodrigues; João Silva Marques; Gustavo Lima da Silva; João de Sousa; Pedro Pinto Cardoso; Fausto J. Pinto

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black">Introduction</span></span></strong><span style="font-family:Calibri,sans-serif"><span style="color:black">: Left atrial appendage occlusion (LAAO) is increasingly used to prevent stroke in patients with atrial fibrillation (AF), particularly those with contraindications to long-term anticoagulation. This approach is particularly relevant for cancer patients, who face a high risk of thromboembolic events and potential complications from anticoagulant therapy. However, data on LAAO in this population are limited.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black">Aim</span></span></strong><span style="font-family:Calibri,sans-serif"><span style="color:black">: To evaluate the safety and efficacy of LAAO in cancer patients with AF compared to those without cancer.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black">Methods</span></span></strong><span style="font-family:Calibri,sans-serif"><span style="color:black">: A single-center retrospective study of patients who underwent percutaneous LAAO between November 2009 and December 2024. Procedure details, complications, CHA2DS2-VASc, and HAS-BLED scores were analyzed. Adjustments for these scores ensured comparable groups. Efficacy was defined as stroke, systemic embolism, or all-cause death. Safety endpoints included procedural complications and major bleeding events. Kaplan-Meier survival analysis was performed to evaluate efficacy and safety outcomes.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black">Results</span></span></strong><span style="font-family:Calibri,sans-serif"><span style="color:black">: Among 215 patients, 42 had a history of cancer (13 gastrointestinal, 10 hematologic, 4 genitourinary). Of these, 15.9% had active cancer, while 84.1% had previous cancer. The mean age was 74.4&plusmn;1.2 years, with 36% male; 55% had permanent AF, and 36% had a prior stroke. Median CHA2DS2-VASc and HAS-BLED scores were comparable between groups (4.1&plusmn;0.2 vs. 4.1&plusmn;0.1, p=NS; 3.2&plusmn;0.2 vs. 3.0&plusmn;0.1, p=NS). Referral reasons for LAAO in cancer patients included gastrointestinal bleeding (41%), high bleeding risk (14%), and anemia (10%). The procedure duration was 86.9&plusmn;5.2 minutes, with a 92.9% success rate, similar to non-cancer patients. Watchman devices were implanted in 39 patients, Amulet devices in the rest, with an average size of 27&plusmn;1 mm (p=NS). No acute procedural complications were observed in cancer patients.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-family:Calibri,sans-serif"><span style="color:black">After the procedure, 26% of patients were on therapy with VKAs and aspirin (used until 2014), 46% were on dual antiplatelet therapy, and 14% were on NOACs, with no differences between the two groups. Major bleeding events occurred in 2 patients (1 genitourinary, 1 gastrointestinal), while minor bleeding events were reported in 7 cases (9 events in cancer patients vs. 22 events in non-cancer patients, p=0.12), as defined by the VARC 3 criteria. During a follow-up of 52.8&plusmn;7.8 months, 18 cancer patients died (none from cardiovascular causes), and 1 patient had an ischemic stroke, representing 0.4% of the patients. No significant differences were found between cancer and non-cancer patients regarding safety (LogRank p=0.44) or efficacy outcomes (LogRank p=0.11).</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black">Conclusion</span></span></strong><span style="font-family:Calibri,sans-serif"><span style="color:black">: In real-world practice, LAAO is a safe and effective option for cancer patients with AF, with outcomes similar to non-cancer patients. It should be considered a valuable strategy for managing these high-risk patients.</span></span></span></span></span></p>