Left Atrial Appendage Occlusion vs. Usual Care in Patients With Atrial Fibrillation and Severe Chronic Kidney Disease

Inclusion Criteria: * Paroxysmal, persistent, or permanent non-valvular atrial fibrillation (AF), documented by electrocardiography performed at screening or within the prior 6 months * Indication for oral anticoagulation as assessed by CHA2DS2-VASc-Score (≥ 2) * Severe to end-stage chronic kidney disease (eGFR \< 30 ml/min as determined by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula) * 18 to 80 years, inclusive * Life expectancy of at least 2 years * Negative pregnancy test for women * Capable of understanding the investigational nature, potential risks and benefits of the study, and able to provide valid informed consent * Written informed consent Exclusion Criteria: * AF due to a reversible cause or a singular occurrence of AF * Conditions other than AF that require anticoagulation * Transient ischemic attack or stroke within previous 3 months * A need for Aspirin (at a dose of \> 162.5 mg/day) or for both Aspirin and Clopidogrel/other antiplatelet drugs (daily administration) other than for clinical investigation * Contraindications or allergies to vitamin K antagonists, Aspirin or Clopidogrel * Previous closure (surgical, interventional) of the left atrial appendage (LAA) * Previous closure of atrial septal defect (ASD) / persistent foramen ovale (PFO) * Active internal bleeding * Thrombocytopenia (\< 100,000 platelets/mm3) * History of or planned organ transplantation * Planned Mitra Clip or transcatheter aortic valve implantation (TAVI) i…