Feasibility of Left Atrial Appendage Occlusion for Left Atrial Appendage Thrombus in Patients With Persistent Atrial...

Area of Science:

• Cardiology
• Interventional Cardiology
• Stroke Prevention

Background:

• Nonvalvular atrial fibrillation (NVAF) increases stroke risk.
• Left atrial appendage (LAA) thrombus formation is a common complication in NVAF.
• Anticoagulation is the standard stroke prevention but carries bleeding risks.

Purpose of the Study:

• To evaluate the safety and feasibility of percutaneous LAA occlusion in NVAF patients with LAA thrombus.
• To compare periprocedural complications between patients with and without LAA thrombus.
• To assess long-term adverse events following LAA occlusion.

Main Methods:

• A Korean multicenter registry included NVAF patients undergoing LAA occlusion from 2010-2016.
• Patients were categorized into groups with (n=10) or without (n=132) preprocedural LAA thrombus.
• Incidences of periprocedural complications and major adverse cardiac events during follow-up were analyzed.

Main Results:

• No significant difference in periprocedural complications (stroke, tamponade, bleeding, embolization) between groups (0% vs 5%, p=0.49).
• Similar rates of major adverse cardiac events during a mean 23.2-month follow-up (14% vs 9%, p=0.47).
• Key events included cardiovascular death and ischemic strokes.

Conclusions:

• Percutaneous LAA occlusion is a safe and feasible alternative for stroke prevention in select NVAF patients with LAA thrombus.
• This approach is particularly suitable for patients with high bleeding risk, anticoagulation contraindications, or failed anticoagulation.
• LAA occlusion offers a viable option when anticoagulation is not optimal.