Author + information
- Jiangtao Yu1,
- Yuan Bai2,
- Manuela Muenzel1,
- Adam Fasakas1,
- Xin Xue3,
- Thorsten Keil1 and
- Erich Duenninger1
Percutaneous left atrial appendage closure (LAAC) has emerged as a alternative for the prevention of strokes in patients (Pat) with atrial fibrillation (AF). However, device-related thrombus (DRT) has been described after LAAC with a number of different devices. In this retrospective analysis with a 4-year follow-up, we aimed to determine the incidence and predisposing factors of DRT in Pat undergoing LAAC with four types of devices from real-world practices.
Between Feb 2012 and Dec 2016, 319 consecutive Pat with AF and moderate-to-high risk of bleeding underwent LAAC using WATCHMAN (WM), WATCHMAN Flx (WMF), Amplatzer cardiac plug, and Amulet devices. All Pat underwent transesophageal echocardiography (TEE) at a minimum of 3 time points: periprocedurally, at 45 days, and at 6 months. Other clinical parameters were also evaluated, and a comparison between Pat with DRT and those not suffering from DRT was done.
The LAAC was successfully performed in 97.8% of the Pat. DRT was detected in 14 (4.5%) Pat: 3 at acute phase, 8 at subacute phase, 2 at late phase, and 1 at very late phase. Among them, 13 Pat were treated with the WM and 1 Pat received the WMF. In 6 out of 14 Pat, DRT was successfully resolved by oral anticoagulation (OAC). No major bleeding and no deaths was recorded during the treatment of DRT. Thrombus recurrence on the WM occurred in 3 Pat when they stopped OAC. As a result, the 3 Pat were to be treated with lifelong warfarin afterward. The remaining 5 Pat with DRT were still under close monitoring. HAS-BLED scores were higher in Pat with DRT than without thrombi. There was a significant association between the presence of peri-device gap and DRT, and ostial peri-device gap after LAAC is associated with an increased risk of DRT. The ostial peri-device gap was the only variable identified as a significant risk factor associated with DRT (P=0.02).
The incidence of DRT was low, as part of the DRT was resolved with OAC. Ostial peri-device gaps may cause a predisposition to DRT. Optimal implantation without peri-device gaps, individual antithrombotic regimens, and careful monitoring with TEE follow-up could be conducive to the prevention of DRT.
ENDOVASCULAR: Stroke and Stroke Prevention