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Introduction: Left atrial appendage (LAA) closure is an alternative to oral anticoagulation in patients with non-valvular atrial fibrillation (AF) at high risk of bleeding. While randomised trials have been performed on patients deemed suitable to receive anticoagulation, our practice has been to perform LAA closure on high risk patients with a contraindication to anticoagulants. We retrospectively reviewed the safety of LAA closure in our unselected cohort.
Methods: A retrospective chart review of all patients who had LAA closure from 2009-2015. Data were collected on periprocedural complications, interventions and admissions required. All procedures were carried out by a single primary operator and under TEE guidance.
Results: One hundred and forty six LAA closures were performed. Charts for 129 (88%) were available. The average age was 77 years (SD 6.5). Ninety six (75%) were male. The average CHADSVASc score was 4 (SD1.5) and HASBLED score was 2.4 (SD 0.7). GI and intracranial bleeding were the main indications. One hundred and seven (83%) had a WATCHMAN, 21 (16%) had an ACP and one had a PLAATO device. One hundred and fourteen (88.3%) were planned as day cases, fourteen were already inpatients (11%) and one was admitted electively.
Fourteen (12%) of the day cases required subsequent admission. One had a pericardial effusion requiring drainage. Three had <1cm effusions with no intervention required. Four had access site ooze. One patient, with a known coagulation disorder developed a femoral haematoma requiring transfusion. Two were in AF with rapid ventricular response. One was thought to have developed a septal haematoma post trans-septal puncture but cardiac MRI showed the lesion to be myocardium. Two were admitted for observation of minor complaints (lightheadedness and headache). There were no device embolisations, periprocedural strokes or deaths.
Conclusions: We found LAA closure to be safe in our high risk patient cohort. A high percentage were sucessfully carried out as day cases. Most admissions were for observation. Major complications were rare. We believe operator experience, TEE expertise and team education are the main contributng factors to our low periprocedural complication rate.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Devices 4
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1278-081
- 2017 American College of Cardiology Foundation