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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Systematic Review of Contiguous Vessel and Valve Injury Associated with Endocardial Left Atrial Appendage Occlusion
Sharan Prakash Sharma1, Ghulam Murtaza2, Bader Madoukh2
1Garden City Hospital, Department of Cardiology, Garden City, Michigan, USA.
Insights
Left atrial appendage occlusion (LAAO) is a common procedure for atrial fibrillation (AF) patients. Oversized devices can cause rare but serious complications, including pulmonary artery injury.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Endocardial left atrial appendage occlusion (LAAO) is increasingly used for atrial fibrillation (AF) patients unsuitable for long-term oral anticoagulation.
- While LAAO procedural safety has improved, rare complications involving adjacent structures are a concern with rising procedure volumes.
Purpose of the Study:
- To systematically review and analyze reported cases of contiguous vessel and mitral valve injury associated with LAAO devices.
- To identify risk factors and common denominators for these rare but severe complications.
Main Methods:
- A systematic literature search was conducted using predefined terms to identify all published cases of LAAO-related contiguous vessel (pulmonary artery, pulmonary vein, left circumflex artery) and mitral valve injury.
- Data from reviewed cases were analyzed to determine device types, injury patterns, and patient outcomes.
Main Results:
- Amplatzer Cardiac Plug (ACP) and Amplatzer Amulet devices were most frequently implicated.
- Pulmonary artery perforation was the most common collateral vessel injury, often linked to the left atrial appendage's proximity to the pulmonary artery.
- Oversized LAAO devices were identified as a common factor in all reviewed injury cases.
- Pulmonary artery injury frequently presented as fatal pericardial tamponade with hemodynamic collapse.
Conclusions:
- Collateral vessel and valve injury following LAAO, particularly with double-lobe devices like ACP and Amulet, can occur.
- Increased operator awareness, meticulous imaging, and appropriate investigations are crucial for mitigating these rare complications.
Abstract:
Endocardial LAAO has been increasingly utilized in atrial fibrillation (AF) patients who are not suitable for long term oral anticoagulation. While overall procedural complications have decreased, rare complications like contiguous vessel and valve injury may be more frequently seen in the future with increase in the procedure volume. We performed a systematic search using predefined terms which reviewed all cases published in literature of contiguous vessel (pulmonary artery, pulmonary vein and left circumflex artery) and mitral valve injury caused by LAAO devices. Our results showed that Amplatzer Cardiac Plug (ACP) and Amplatzer Amulet devices were the most commonly used devices. Pulmonary artery perforation was the most commonly seen collateral vessel injury associated with LAAO. Close proximity of left atrial appendage to pulmonary artery was noted in all cases of pulmonary artery injury. Pulmonary artery injury commonly manifests as pericardial tamponade with hemodynamic collapse and is often fatal. Most common denominator of all the reviewed cases was the presence of an oversized LAAO device. In conclusion, collateral vessels and valve injury can be seen after LAAO mostly with double lobe devices such as ACP or Amulet. Increased awareness by the operators along with proper imaging and investigations could potentially mitigate such rare complications associated with LAAO.
