Sharan Prakash Sharma1, Jie Cheng2, Mohit K Turagam3, Rakesh Gopinathannair1, Rodney Horton2, Yat-Yin Lam4, Giuseppe Tarantini5, Gianpiero D'Amico5, Xavier Freixa Rofastes6, Mathias Lange7, Andrea Natale2, Dhanunjaya R Lakkireddy8. 1. Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA. 2. Texas Cardiac Arrhythmia Institute, Austin, Texas. 3. Icahn School of Medicine at Mount Sinai, New York, New York, USA. 4. Department of Cardiology, Prince of Wales Hospital, Hong Kong. 5. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy. 6. Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain. 7. Department of Cardiology, Heart Center Osnabrück, Osnabrück, Germany. 8. Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA. Electronic address: dhanunjaya.lakkireddy@hcahealthcare.com.
Abstract
OBJECTIVES: This study aimed to investigate the feasibility and safety of left atrial appendage occlusion (LAAO) procedures in patients with persistent left atrial appendage (LAA) thrombus. BACKGROUND: The left atrial appendage (LAA) is the most common site of thrombus formation in patients with nonvalvular atrial fibrillation (AF). Oral anticoagulation (OAC) is used to prevent and treat AF-related thrombus. However, a significant proportion of patients may not be eligible for long-term OAC therapy. In many cases, OAC may fail to resolve the thrombus. Left atrial appendage occlusion (LAAO) may be a potential option in such cases. Major LAAO studies have excluded patients with LAA thrombus, and it is not known whether LAAO procedures in the presence of LAA thrombus is feasible and safe. METHODS: This was a systematic review of patient-level data of all published cases of LAAO in the presence of LAA thrombus. RESULTS: There was a total of 58 patients included in the study. Most of the patients had a distally located thrombus in the LAA. All cases underwent successful implantation of LAAO devices with some procedural modifications. Amulet was the most commonly used device (50%). A cerebral protection device was used in 17 (29%) patients, and procedural transesophageal echocardiography was used in most of the cases. One stroke (1.7%) and 2 (3.4%) device-related thromboses were noted during the mean follow-up of 3.4 ± 7 months. CONCLUSIONS: Percutaneous LAAO procedures appear to be feasible in patients with a distally located persistent LAA thrombus when performed by experienced operators with some technical modifications. Further studies are required to determine the long-term safety and efficacy of this approach.
OBJECTIVES: This study aimed to investigate the feasibility and safety of left atrial appendage occlusion (LAAO) procedures in patients with persistent left atrial appendage (LAA) thrombus. BACKGROUND: The left atrial appendage (LAA) is the most common site of thrombus formation in patients with nonvalvular atrial fibrillation (AF). Oral anticoagulation (OAC) is used to prevent and treat AF-related thrombus. However, a significant proportion of patients may not be eligible for long-term OAC therapy. In many cases, OAC may fail to resolve the thrombus. Left atrial appendage occlusion (LAAO) may be a potential option in such cases. Major LAAO studies have excluded patients with LAA thrombus, and it is not known whether LAAO procedures in the presence of LAA thrombus is feasible and safe. METHODS: This was a systematic review of patient-level data of all published cases of LAAO in the presence of LAA thrombus. RESULTS: There was a total of 58 patients included in the study. Most of the patients had a distally located thrombus in the LAA. All cases underwent successful implantation of LAAO devices with some procedural modifications. Amulet was the most commonly used device (50%). A cerebral protection device was used in 17 (29%) patients, and procedural transesophageal echocardiography was used in most of the cases. One stroke (1.7%) and 2 (3.4%) device-related thromboses were noted during the mean follow-up of 3.4 ± 7 months. CONCLUSIONS: Percutaneous LAAO procedures appear to be feasible in patients with a distally located persistent LAA thrombus when performed by experienced operators with some technical modifications. Further studies are required to determine the long-term safety and efficacy of this approach.
Authors: Luis Marroquin; Gabriela Tirado-Conte; Radosław Pracoń; Witold Streb; Hipolito Gutierrez; Giacomo Boccuzzi; Dabit Arzamendi-Aizpurua; Ignacio Cruz-González; Juan Miguel Ruiz-Nodar; Jung-Sun Kim; Xavier Freixa; Jose Ramon Lopez-Minguez; Ole De Backer; Rafael Ruiz-Salmeron; Antonio Dominguez; Angela McInerney; Vicente Peral; Rodrigo Estevez-Loureiro; Eduard Fernandez-Nofrerias; Afonso B Freitas-Ferraz; Francesco Saia; Zenon Huczek; Livia Gheorghe; Pablo Salinas; Marcin Demkow; Jose R Delgado-Arana; Estefania Fernandez Peregrina; Zbibniew Kalarus; Ana Elvira Laffond; Yangsoo Jang; Jose Carlos Fernandez Camacho; Oh-Hyun Lee; Jose M Hernández-Garcia; Caterina Mas-Llado; Berenice Caneiro Queija; Ignacio J Amat-Santos; Maciej Dabrowski; Josep Rodés-Cabau; Luis Nombela Franco Journal: Heart Date: 2022-06-24 Impact factor: 7.365