Radoslaw Litwinowicz1, Marian Burysz2, Piotr Mazur1, Boguslaw Kapelak1, Magdalena Bartus3, Dhanunjaya Lakkireddy4, Randall J Lee5, Michalina Malec-Litwinowicz6, Krzysztof Bartus1. 1. Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland. 2. Department of Cardiac Surgery, Regional Specialist Hospital, Grudziadz, Poland. 3. Departament of Pharmacology, Jagiellonian University Medical College, Krakow, Poland. 4. The Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, Kansas, USA. 5. Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, California, USA. 6. Departament of Neurology, John Paul II Hospital, Krakow, Poland.
Abstract
BACKGROUND: Left atrial appendage closure (LAAC) became an alternative method for stroke prevention in patients with non-valvular atrial fibrillation (AF) intolerant to long term oral anticoagulation therapy. This study aimed to compare endocardial (Amulet and LAmbere occluders) and epicardial (Lariat) LAAC techniques. METHODS: A retrospective, observational case-control study included 223 consecutive CHA2 DS2 -VAS score-matched patients with AF who underwent LAAC in two centers. RESULTS: There were 55 matched cases with the mean CHA2DS2-VASs score 4.4 ± 1.22 (p = 1). Overall follow-up was 308.2 patient-years. The Endocardial group patients were older and more often females with congestive heart failure and peripheral vascular disease. The epicardial group more frequently had a stroke/transient ischemic attack history. There were no differences in hypertension, diabetes mellitus, and indications for procedure between both groups. The mean HAS-BLED score was significantly higher in the endocardial group than in the epicardial group (4.3 ± 0.9 vs. 3.7 ± 1.3, p = .011). There were no differences in annual rates of thromboembolic events (2.6% vs 0.5%) and annual stroke (0.87% vs. 0%) between the endocardial and epicardial groups. CONCLUSION: Endocardial and Epicardial LAAC techniques show comparable implantation outcomes and safety profile and stroke prevention in patients with AF. Future randomized studies are needed to corroborate these initial results and assess long term mortality.
BACKGROUND: Left atrial appendage closure (LAAC) became an alternative method for stroke prevention in patients with non-valvular atrial fibrillation (AF) intolerant to long term oral anticoagulation therapy. This study aimed to compare endocardial (Amulet and LAmbere occluders) and epicardial (Lariat) LAAC techniques. METHODS: A retrospective, observational case-control study included 223 consecutive CHA2 DS2 -VAS score-matched patients with AF who underwent LAAC in two centers. RESULTS: There were 55 matched cases with the mean CHA2DS2-VASs score 4.4 ± 1.22 (p = 1). Overall follow-up was 308.2 patient-years. The Endocardial group patients were older and more often females with congestive heart failure and peripheral vascular disease. The epicardial group more frequently had a stroke/transient ischemic attack history. There were no differences in hypertension, diabetes mellitus, and indications for procedure between both groups. The mean HAS-BLED score was significantly higher in the endocardial group than in the epicardial group (4.3 ± 0.9 vs. 3.7 ± 1.3, p = .011). There were no differences in annual rates of thromboembolic events (2.6% vs 0.5%) and annual stroke (0.87% vs. 0%) between the endocardial and epicardial groups. CONCLUSION: Endocardial and Epicardial LAAC techniques show comparable implantation outcomes and safety profile and stroke prevention in patients with AF. Future randomized studies are needed to corroborate these initial results and assess long term mortality.
Authors: Krzysztof Bartus; Sri Harsha Kanuri; Radoslaw Litwinowicz; Mehmet Ali Elbey; Joanna Natorska; Michal Zabczyk; Magdalena Bartus; Boguslaw Kapelak; Rakesh Gopinnathannair; Jalaj Garg; Mohit K Turagam; Maciej T Malecki; Randall J Lee; Dhanunjaya Lakkireddy Journal: J Clin Med Date: 2022-03-09 Impact factor: 4.241