Varuna K Gadiyaram1, Sanghamitra Mohanty2,3, Carola Gianni2, Chintan Trivedi2, Amin Al-Ahmad2, David J Burkhardt2, Joseph G Gallinghouse2, Patrick M Hranitzky2, Rodney P Horton2, Javier E Sanchez2, Domenico G Della Rocca1, Luigi Di Biase2,4,5,6, Matthew J Price1, Linda Couts1, Douglas Gibson7, Andrea Natale1,2,3,4,8,9. 1. Department of Interventional Electrophysiology, Scripps Clinic, La Jolla, California. 2. Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas. 3. Dell Medical School, University of Texas, Austin, Texas. 4. Department of Biomedical Engineering, University of Texas, Austin, Texas. 5. Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. 6. Department of Internal Medicine and Cardiology, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy. 7. Department of Cardiac Electrophysiology, Scripps Clinic, La Jolla, CA. 8. Department of Electrophysiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. 9. Division of Cardiology, Stanford University, Stanford, California.
Abstract
INTRODUCTION: Electrical isolation of the left atrial appendage (LAA) is an important adjunctive ablation strategy in patients with nonparoxysmal atrial fibrillation (AF). Patients who have impaired LAA contractility following isolation may require long-term oral anticoagulant (OAC) therapy irrespective of their CHADS2 -VASc score. Percutaneous LAA occlusion (LAAO) is a potential alternative to life-long OAC therapy. We aimed to assess the rate of OAC discontinuation and thromboembolic (TE) events following percutaneous LAAO in patients who underwent LAA electrical isolation (LAAI). METHODS: This is a retrospective two-center study of patients who underwent percutaneous LAAO following LAAI. Patients with at least 3-month follow-up were included in the study. The antithrombotic therapy and TE events at the time of the last follow-up were noted. RESULTS: The LAA was successfully occluded in 162 (with Watchman device in 140 [86.4%] and Lariat in 22 [13.6%]). A total of 32 patients had leaks detected on the 45-day transesophageal echocardiogram (TEE); 21 (15%) Watchman and 11 (50%) Lariat cases (P = 0.0001). Two (one Watchman and one Lariat) of the 32 leaks were more than 5 mm. After the 45-day TEE, 150 (92.6%) patients were off-OAC. No TE events were reported in the 150 patients who stopped the anticoagulants. Four (2.47%) patients experienced stroke following the LAAO (three Watchman and one Lariat) procedure while on-OAC, two of which were fatal. At the median follow-up of 18.5 months, 159 (98.15%) patients were off-anticoagulant. CONCLUSION: Up to 98% of patients with LAAI could safely discontinue OAC after undergoing the appendage closure procedure.
INTRODUCTION: Electrical isolation of the left atrial appendage (LAA) is an important adjunctive ablation strategy in patients with nonparoxysmal atrial fibrillation (AF). Patients who have impaired LAA contractility following isolation may require long-term oral anticoagulant (OAC) therapy irrespective of their CHADS2 -VASc score. Percutaneous LAA occlusion (LAAO) is a potential alternative to life-long OAC therapy. We aimed to assess the rate of OAC discontinuation and thromboembolic (TE) events following percutaneous LAAO in patients who underwent LAA electrical isolation (LAAI). METHODS: This is a retrospective two-center study of patients who underwent percutaneous LAAO following LAAI. Patients with at least 3-month follow-up were included in the study. The antithrombotic therapy and TE events at the time of the last follow-up were noted. RESULTS: The LAA was successfully occluded in 162 (with Watchman device in 140 [86.4%] and Lariat in 22 [13.6%]). A total of 32 patients had leaks detected on the 45-day transesophageal echocardiogram (TEE); 21 (15%) Watchman and 11 (50%) Lariat cases (P = 0.0001). Two (one Watchman and one Lariat) of the 32 leaks were more than 5 mm. After the 45-day TEE, 150 (92.6%) patients were off-OAC. No TE events were reported in the 150 patients who stopped the anticoagulants. Four (2.47%) patients experienced stroke following the LAAO (three Watchman and one Lariat) procedure while on-OAC, two of which were fatal. At the median follow-up of 18.5 months, 159 (98.15%) patients were off-anticoagulant. CONCLUSION: Up to 98% of patients with LAAI could safely discontinue OAC after undergoing the appendage closure procedure.
Authors: Kenneth Kita; Steven Carlson; Mary Huntsinger; Han Tun; Jina Sohn; Rahul N Doshi Journal: J Interv Card Electrophysiol Date: 2019-08-03 Impact factor: 1.900