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Background: Closure of the left atrial appendage (LAA) is now commonly used in patients with atrial fibrillation who are poor candidates for long term oral anti-coagulation (OAC). Thrombus formation over the device necessitates continuation or restarting of OAC. There are no guidelines to manage this subset of patients.
Methods: We retrospectively analyzed 149 patients who underwent watchman device (WD) implant at our site between 2007 and 2011. All patients had baseline TTE and TEE before placement of a WD. Post-implant TEE was repeated at 45 days, 6 and 12 months. All patients were treated with warfarin for 45 days post implant. Warfarin was discontinued when no thrombus was seen at follow up TEE. All patients with thrombus formation were started on a 3-month regimen of warfarin with a target INR of 2.5-3.5. A repeat TEE was performed at 3 monthly intervals to assess for clot resolution. After complete resolution of the thrombus, warfarin was continued for another 3 months to allow for endothelialization. These patients underwent another TEE at 3 months after warfarin discontinuation to assess for recurrence of thrombus formation.
Results: Patients that developed LA thrombus were older, had lower EF, and more hypertensive. All patients but one who developed LA thrombus, had thrombus resolution within treatment protocol. No thromboembolic events were noted.
Conclusions: Our treatment strategy was highly successful for management of LA thrombus and eventual discontinuation of OAC after WD implant.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Innovative Approaches for Reducing Risk and Improving Outcomes With Ablation
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1237-099
- 2017 American College of Cardiology Foundation