Jing Xu1, Chuan Zhi Chen2, Jun Xing2, Liang Wang1, Yi Rao Tao3, Bing Yang1, Qi Zhang1, Yun Li Shen4, Jian Qiang Hu5. 1. Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Ji Mo Rd, 200120, Shanghai, China. 2. Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. 3. Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China. 4. Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Ji Mo Rd, 200120, Shanghai, China. shenyunli2011@163.com. 5. Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Ji Mo Rd, 200120, Shanghai, China. hujq163@126.com.
Abstract
PURPOSE: This study aimed to assess the incidence, potential risk factors and clinical impact of incomplete device endothelialization(IDE) after left atrial appendage closure (LAAC). METHODS: A total of 101 consecutive patients with nonvalvular atrial fibrillation (AF) who underwent successful LAAC and received antithrombotic treatment using a standard regimen were prospectively followed up to 6 months after the procedure. The status of device endothelialization and device-related thrombus (DRT) were evaluated using cardiac computed tomography (CT). Major adverse cardio-cerebral events (MACCE) including all-cause death, heart failure(HF) hospitalization, acute ischemic stroke, transient ischemic attack(TIA), peripheral vascular embolism, and major bleeding were recorded. RESULTS: IDE was detected in 65 (64.4%) patients. Patients with IDE or complete device endothelialization (CDE) did not significantly differ with respect to baseline clinical characteristics and interventional procedure features. Multivariate analysis model revealed that persistent AF, left atrial appendage ostial diameter and left atrial size were independent risk factors for IDE. During 6-month follow-up, the incidence of DRT was 4.6% in patients with IDE and 2.8% in those with CDE, respectively (p > 0.05), and the overall rate of MACCE was non-significantly higher in the IDE group (7.7% vs. 2.8%, p = 0.32). CONCLUSION: IDE is common after LAAC, especially in patients with persistent AF, higher left atrial appendage ostial diameter and left atrial size. IDE confers an increased risk for DRT, but may be not necessarily associated with thromboembolic events and poor clinical outcome, providing careful monitoring and continued antithrombotic therapy are given.
PURPOSE: This study aimed to assess the incidence, potential risk factors and clinical impact of incomplete device endothelialization(IDE) after left atrial appendage closure (LAAC). METHODS: A total of 101 consecutive patients with nonvalvular atrial fibrillation (AF) who underwent successful LAAC and received antithrombotic treatment using a standard regimen were prospectively followed up to 6 months after the procedure. The status of device endothelialization and device-related thrombus (DRT) were evaluated using cardiac computed tomography (CT). Major adverse cardio-cerebral events (MACCE) including all-cause death, heart failure(HF) hospitalization, acute ischemic stroke, transient ischemic attack(TIA), peripheral vascular embolism, and major bleeding were recorded. RESULTS: IDE was detected in 65 (64.4%) patients. Patients with IDE or complete device endothelialization (CDE) did not significantly differ with respect to baseline clinical characteristics and interventional procedure features. Multivariate analysis model revealed that persistent AF, left atrial appendage ostial diameter and left atrial size were independent risk factors for IDE. During 6-month follow-up, the incidence of DRT was 4.6% in patients with IDE and 2.8% in those with CDE, respectively (p > 0.05), and the overall rate of MACCE was non-significantly higher in the IDE group (7.7% vs. 2.8%, p = 0.32). CONCLUSION: IDE is common after LAAC, especially in patients with persistent AF, higher left atrial appendage ostial diameter and left atrial size. IDE confers an increased risk for DRT, but may be not necessarily associated with thromboembolic events and poor clinical outcome, providing careful monitoring and continued antithrombotic therapy are given.
Authors: Apostolos Tzikas; David R Holmes; Sameer Gafoor; Carlos E Ruiz; Carina Blomström-Lundqvist; Hans-Christoph Diener; Riccardo Cappato; Saibal Kar; Randal J Lee; Robert A Byrne; Reda Ibrahim; Dhanunjaya Lakkireddy; Osama I Soliman; Michael Nabauer; Steffen Schneider; Johannes Brachmann; Jeffrey L Saver; Klaus Tiemann; Horst Sievert; A John Camm; Thorsten Lewalter Journal: Europace Date: 2016-08-18 Impact factor: 5.214