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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Risk factors for thrombus formation on the Amplatzer Cardiac Plug after left atrial appendage occlusion

Bjoern Plicht1, Thomas F M Konorza, Philipp Kahlert

  • 1Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany. bjoern.plicht@uk-essen.de

JACC. Cardiovascular Interventions
|June 22, 2013
PubMed

Insights

Thrombus formation on the Amplatzer Cardiac Plug (ACP) occurred in 17.6% of patients despite dual antiplatelet therapy. Higher CHADS2 and CHA2DS2-VASc scores, platelet count, and lower ejection fraction are key risk factors.

Area of Science:

  • Cardiology
  • Medical Devices
  • Thrombosis Research

Background:

  • Left atrial appendage occlusion (LAAO) using the Amplatzer Cardiac Plug (ACP) is an alternative to anticoagulation for preventing stroke in atrial fibrillation patients.
  • Vitamin K antagonists are associated with bleeding complications, making LAAO a viable option for selected patients.

Purpose of the Study:

  • To identify risk factors for thrombus formation on the ACP after left atrial appendage occlusion.
  • To evaluate the incidence of ACP thrombosis in patients with atrial fibrillation receiving dual antiplatelet therapy.

Main Methods:

  • Transesophageal echocardiography was performed at multiple time points (pre-discharge, 3, 6, and 12 months) in 34 patients undergoing ACP implantation.
  • Retrospective analysis of clinical, echocardiographic, and hemostaseological parameters was conducted to determine risk factors for thrombus formation.

Main Results:

  • Thrombus formation on the ACP was observed in 17.6% of patients (6 out of 34).
  • Patients with thrombi had significantly higher CHADS2 and CHA2DS2-VASc scores, increased pre-interventional platelet counts, and lower ejection fractions compared to those without thrombi.
  • No significant differences were noted in left atrial volume, appendage velocity, spontaneous echo contrast, transmitral gradient, or mitral regurgitation between groups.

Conclusions:

  • Transesophageal echocardiography is effective in detecting thrombus formation on the ACP.
  • Elevated CHADS2 and CHA2DS2-VASc scores, higher platelet count, and reduced ejection fraction are significant risk factors for ACP thrombosis, even with dual antiplatelet therapy.
Abstract

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