Real-world survival data of device-related thrombus following left atrial appendage closure: 4-year experience from a...

Area of Science:

• Cardiology
• Medical Devices
• Thrombosis

Background:

• Percutaneous left atrial appendage closure (LAAC) is an alternative to oral anticoagulation for stroke prevention in atrial fibrillation.
• Device-related thrombus (DRT) is a potential complication following LAAC, necessitating further investigation into its incidence and risk factors in real-world settings.

Purpose of the Study:

• To estimate the incidence and identify risk factors for device-related thrombus (DRT) after percutaneous LAAC in a real-world patient cohort.
• To evaluate the resolution of DRT with oral anticoagulation and identify factors associated with its occurrence.

Main Methods:

• A retrospective analysis of 319 patients undergoing percutaneous LAAC with various devices (WATCHMAN, Amplatzer, Amulet) between 2012 and 2016.
• Transesophageal echocardiography (TEE) performed at periprocedural, 45-day, and 6-month follow-ups to assess for DRT.
• Comparison of clinical parameters, including HAS-BLED score and presence of peri-device leak, between patients with and without DRT.

Main Results:

• Successful LAAC was achieved in 97.8% of patients.
• DRT was detected in 14 patients (4.49%), primarily originating from the device screw, with varying detection times (acute to very late phases).
• Higher HAS-BLED scores (p=0.042) and residual peri-device leaks (p=0.023) were significantly associated with DRT.
• Oral anticoagulation led to successful DRT resolution in 6 out of 14 affected patients.

Conclusions:

• The incidence of DRT after LAAC in real-world practice is acceptable and potentially manageable with oral anticoagulation.
• Residual peri-device leak is a significant risk factor predisposing to DRT formation.
• Optimal device implantation, individualized antithrombotic strategies, and diligent TEE monitoring are crucial for DRT prevention.