Authors:

Khushi Sharma

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Chronic kidney disease (CKD) is common among patients with atrial fibrillation (AF) and is associated with both increased thromboembolic risk and heightened bleeding risk, complicating long-term anticoagulation management. Left atrial appendage occlusion (LAAO) with the Watchman device offers an alternative strategy for stroke prevention, yet it remains unclear whether baseline kidney dysfunction impacts post-procedural outcomes. We performed a retrospective cohort study of 117 patients undergoing Watchman implantation, stratified by presence of CKD (n=53) versus no CKD (n=64). Baseline characteristics and clinical outcomes at 6- and 12-month follow-up were compared using t-tests and Fisher's exact tests. The groups were well balanced in age (71.0+10.1 vs 72.428.3 years, p=0.44) and hypertension prevalence (90.6% in both groups, p=1.00). As expected, diabetes was more prevalent in the CKD group (67.9% vs 48.4%, p=0.04), and mean HAS-BLED scores were significantly higher (4.36+0.92 vs 3.06+1.15, p<0.001). Despite this higher comorbidity burden, there were no significant differences in major clinical outcomes. Six-month stroke rates were similar (1.9% vs 1.6%, p=1.00), as were major bleeding events (11.3% vs 15.6%, p=0.59), all-cause readmissions (24.5% vs 31.2%, p=0.54), and expanded major adverse cardiovascular events (17.0% vs 20.3%, p=0.81). At 12 months, stroke, major bleeding, and all-cause readmission rates remained unchanged from 6-month follow-up, while expanded major adverse cardiovascular events were 17.0% vs 21.9% (p=0.64). There were no deaths at either 6 or 12 months in both groups. In this single-center cohort, patients with CKD undergoing Watchman implantation experienced comparable short- and intermediate-term outcomes to those without CKD despite higher baseline bleeding risk. These findings suggest that CKD alone should not preclude consideration of LAAO in appropriately selected patients.

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University of Illinois Chicago

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Co-authors:

Khushi Sharma