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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Device-Related Thrombus After Left Atrial Appendage Closure: Data on Thrombus Characteristics, Treatment Strategies,
Alexander Sedaghat1, Vivian Vij1, Baravan Al-Kassou1
1University Hospital Bonn, Germany (A.S., V.V., B.A.-K., J.W.S., G.N.).
Insights
Device-related thrombosis (DRT) after left atrial appendage closure is linked to high stroke and mortality risks. While most DRTs resolve with treatment, incomplete resolution indicates a poorer prognosis, necessitating optimized diagnostic and treatment strategies.
Area of Science:
- Cardiology
- Medical Devices
- Thrombosis Research
Background:
- Left atrial appendage closure is a standard treatment for atrial fibrillation.
- Device-related thrombosis (DRT) is a rare but serious complication.
- Limited data exists on DRT characteristics, outcomes, and optimal treatment.
Purpose of the Study:
- To assess the characteristics, outcomes, and treatment regimens of DRT in patients who underwent left atrial appendage closure.
- To evaluate the long-term risks associated with DRT and its resolution status.
Main Methods:
- A multinational registry (EURO-DRT) included 156 patients diagnosed with DRT post-left atrial appendage closure.
- Collected baseline clinical and echocardiographic data.
- Monitored DRT dynamics, treatment success, and patient outcomes through follow-up.
Main Results:
- DRT was detected a median of 93 days post-procedure, with 17.9% detected after 6 months.
- Patients had high ischemic and bleeding risk scores, with prevalent nonparoxysmal atrial fibrillation and prior stroke.
- Complete DRT resolution was achieved in 79.5% of patients after treatment adjustment. Two-year follow-up showed high mortality (20.0%) and ischemic stroke (13.8%) rates.
Conclusions:
- A significant portion of DRT is diagnosed late, underscoring the need for imaging follow-up.
- DRT patients face elevated risks of stroke and mortality.
- Incomplete DRT resolution is associated with worse outcomes, highlighting the need for refined diagnostic criteria and treatment protocols.
Background:
Left atrial appendage closure is an established therapy in patients with atrial fibrillation. Although device-related thrombosis (DRT) is relatively rare, it is potentially linked to adverse events. As data on DRT characteristics, outcome, and treatment regimen are scarce, we aimed to assess these questions in a multicenter approach.
Methods:
One hundred fifty-six patients with the diagnosis of DRT after left atrial appendage closure were included in the multinational EUROC-DRT registry. Baseline characteristics included clinical and echocardiographic data. After inclusion, all patients underwent further clinical and echocardiographic follow-up to assess DRT dynamics, treatment success, and outcome.
Results:
DRT was detected after a median of 93 days (interquartile range, 54–161 days) with 17.9% being detected >6 months after left atrial appendage closure. Patients with DRT were at high ischemic and bleeding risk (CHA2DS2-VASc 4.5±1.7, HAS-BLED 3.3±1.2) and had nonparoxysmal atrial fibrillation (67.3%), previous stroke (53.8%), and spontaneous echo contrast (50.6%). The initial treatment regimens showed comparable resolution rates (antiplatelet monotherapy: 57.1%, dual antiplatelet therapy: 85.7%, vitamin K antagonists: 80.0%, novel oral anticoagulants: 75.0%, and heparin: 68.6%). After intensification or switch of treatment, complete DRT resolution was achieved in 79.5% of patients. Two-year follow-up revealed a high risk of mortality (20.0%) and ischemic stroke (13.8%) in patients with DRT. Patients with incomplete DRT resolution showed numerically higher stroke rates and increased mortality rates (stroke: 17.6% versus 12.3%, P=0.29; mortality: 31.3% versus 13.1%, P=0.05).
Conclusions:
A substantial proportion of DRT is detected >6 months after left atrial appendage closure, highlighting the need for imaging follow-up. Patients with DRT appear to be at a high risk for stroke and mortality. While DRT resolution was achieved in most patients, incomplete DRT resolution appeared to identify patients at even higher risk. Optimal DRT diagnostic criteria and treatment regimens are warranted.
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