Left Atrial Appendage Occlusion Among Cancer Patients with Atrial Fibrillation: a systematic review and update meta-analysis

Left atrial appendage occlusion (LAAO) is a well-established therapy for atrial fibrillation (AF) in patients with contraindications to oral anticoagulation. However, the clinical outcomes of LAAO in patients with cancer remain poorly defined. Therefore, we performed an updated meta-analysis to evaluate the safety and efficacy of LAAO in patients with cancer. PubMed, Embase and Cochrane databases were systematically searched for studies evaluating LAAO in patients with AF and cancer. Our endpoints of interest were long-term stroke, bleeding and all-cause mortality. We reported the endpoints in Hazard Ratio (HR), Odds Ratio (OR) and 95% confidence intervals (95%CI). Additionally, a prespecified subgroup analysis comparing patients with active and history of cancer was performed. Heterogeneity was assessed using the I2 statistic. We included 9 studies with 209,325 patients, of whom 39,3% were female and had a mean age of 77 years. Cancer was significantly associated with higher long-term all-cause mortality (HR 1.64, 95% CI 1.20-2.23; p= 0.002). However, no significant associations were observed for long-term stroke (HR 0.59, 95% CI 0.30-1.15; p=0.12), long-term bleeding (HR 1.02, 95% CI 0.57-1.83; p=0.94). No significant difference was observed between active and history of cancer subgroups (p=0.146). In this meta-analysis, cancer was associated with higher long-term mortality in patients who underwent LAAO. Nevertheless, there was no difference between cancer and non-cancer groups' risk for thromboembolic or bleeding events.