Trevor Simard1, Richard G Jung2, Kyle Lehenbauer3, Kerstin Piayda4, Radoslaw Pracoń5, Gregory G Jackson6, Eduardo Flores-Umanzor7, Laurent Faroux8, Kasper Korsholm9, Julian K R Chun10, Shaojie Chen10, Moniek Maarse11, Kristi Montrella12, Zakeih Chaker13, Jocelyn N Spoon14, Luigi E Pastormerlo15, Felix Meincke16, Abhishek C Sawant17, Carmen M Moldovan18, Mohammed Qintar19, Mehmet K Aktas20, Luca Branca21, Andrea Radinovic22, Pradhum Ram23, Rayan S El-Zein24, Thomas Flautt25, Wern Yew Ding26, Bassel Sayegh27, Tomás Benito-González28, Oh-Hyun Lee29, Solomon O Badejoko30, Christina Paitazoglou31, Nabeela Karim32, Ahmed M Zaghloul33, Himanshu Agrawal34, Rachel M Kaplan35, Oluseun Alli36, Aamir Ahmed37, Hussam S Suradi37, Bradley P Knight35, Venkata M Alla34, Sidakpal S Panaich33, Tom Wong32, Martin W Bergmann31, Rashaad Chothia30, Jung-Sun Kim29, Armando Pérez de Prado28, Raveen Bazaz38, Dhiraj Gupta26, Miguel Valderrabano25, Carlos E Sanchez24, Mikhael F El Chami23, Patrizio Mazzone22, Marianna Adamo21, Fred Ling20, Dee Dee Wang19, William O'Neill19, Wojtek Wojakowski18, Ashish Pershad17, Sergio Berti15, Daniel Spoon14, Akram Kawsara13, George Jabbour12, Lucas V A Boersma11, Boris Schmidt10, Jens Erik Nielsen-Kudsk9, Josep Rodés-Cabau8, Xavier Freixa7, Christopher R Ellis6, Laurent Fauchier39, Marcin Demkow5, Horst Sievert40, Michael L Main3, Benjamin Hibbert2, David R Holmes41, Mohamad Alkhouli42. 1. Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. Electronic address: https://twitter.com/tjsimard. 2. Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 3. Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA. 4. CardioVascular Center Frankfurt, Frankfurt, Germany; Heinrich-Heine-University, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany. 5. Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland. 6. Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA. 7. Department of Cardiology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain. 8. Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. 9. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. 10. Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany. 11. Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands. 12. University of Pittsburgh Medical Center Heart and Vascular Institute, University of Pittsburgh, Altoona, Pennsylvania, USA. 13. Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA. 14. International Heart Institute of Montana, Missoula, Montana, USA. 15. Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy. 16. Asklepios Klinik St Georg, Hamburg, Germany. 17. Banner University Medical Center, Phoenix, Arizona, USA. 18. Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland. 19. Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA. 20. Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA. 21. Catheterization Laboratory, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy. 22. Arrhythmology Department, San Raffaele University Hospital, Milan, Italy. 23. Emory University Hospital, Atlanta, Georgia, USA. 24. Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA. 25. Houston Methodist Hospital, Houston, Texas, USA. 26. Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. 27. Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; The Heart, Lung and Vascular Institute, Excela Health, Pittsburgh, Pennsylvania, USA. 28. Department of Cardiology, University Hospital of León, León, Spain. 29. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. 30. Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA. 31. Cardiologicum Hamburg, Hamburg, Germany. 32. Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom. 33. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. 34. Creighton University School of Medicine, Omaha, Nebraska, USA. 35. Northwestern University, Bluhm Cardiovascular Institute, Chicago, Illinois, USA. 36. Division of Cardiology, Novant Health Heart and Vascular Institute, Charlotte, North Carolina, USA. 37. Rush University Medical Center, Chicago, Illinois, USA. 38. Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 39. Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais, Tours, France. 40. CardioVascular Center Frankfurt, Frankfurt, Germany. 41. Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. 42. Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. Electronic address: Alkhouli.Mohamad@mayo.edu.
Abstract
BACKGROUND: Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. OBJECTIVES: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. METHODS: Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. RESULTS: A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. CONCLUSIONS: DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.
BACKGROUND: Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. OBJECTIVES: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. METHODS: Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. RESULTS: A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. CONCLUSIONS: DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.
Authors: Palak Patel; Nagapratap Ganta; Giuseppe Filice; Ivan Richard; Frederick Acquah; Dina Alnabwani; Harshil B Patel Journal: Cureus Date: 2022-07-15
Authors: Guy Rozen; Gilad Margolis; Ibrahim Marai; Ariel Roguin; Eldad Rahamim; David Planer; Edwin Kevin Heist; Offer Amir; Ilgar Tahiroglu; Jeremy Ruskin; Moussa Mansour; Gabby Elbaz-Greener Journal: Front Cardiovasc Med Date: 2022-09-13