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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Spontaneous Echo Contrast and Ischemic Stroke in Patients Undergoing Percutaneous Left Atrial Appendage
Binhao Wang1, Zhao Wang2, Guohua Fu1
1Arrhythmia Center, Ningbo First Hospital, Ningbo, China.
Insights
Moderate to severe left atrial spontaneous echo contrast (SEC) in atrial fibrillation (AF) patients undergoing left atrial appendage closure (LAAC) is linked to increased device-related thrombus and late stroke risk. Periprocedural stroke risk was not significantly affected.
Area of Science:
- Cardiology
- Interventional Cardiology
- Echocardiography
Background:
- Spontaneous echo contrast (SEC) in the left atrium (LA) is common in atrial fibrillation (AF) patients and associated with thromboembolic events.
- Left atrial appendage closure (LAAC) is a strategy to reduce stroke risk in AF patients.
- The specific impact of LA SEC on stroke risk following LAAC requires further investigation.
Purpose of the Study:
- To evaluate the association between left atrial spontaneous echo contrast (LA SEC) and both periprocedural and long-term stroke risks in patients undergoing percutaneous left atrial appendage closure (LAAC).
- To identify LA SEC as a potential predictor of adverse events after LAAC.
Main Methods:
- A cohort of 408 AF patients undergoing LAAC were stratified into moderate/severe LA SEC (study group, n=41) and none/mild/mild-to-moderate LA SEC (control group, n=367) based on preprocedural transesophageal echocardiography.
- Propensity score matching was employed to balance baseline covariates between the groups.
- Outcomes assessed included periprocedural stroke/TIA, device-related thrombus, and late stroke/TIA during a mean follow-up of 3.2 years.
Main Results:
- No periprocedural strokes or TIAs were observed in either group.
- The incidence of device-related thrombus was significantly higher in the moderate/severe LA SEC group (8.8%) compared to the control group (1.3%).
- Patients with moderate/severe LA SEC had a higher incidence of late stroke/TIA (9.8% vs. 2.2%) and moderate/severe LA SEC was an independent predictor of stroke/TIA in both original and matched populations.
Conclusions:
- Left atrial spontaneous echo contrast (LA SEC) does not appear to increase periprocedural stroke risk in patients undergoing percutaneous left atrial appendage closure (LAAC).
- However, moderate to severe LA SEC is associated with a higher incidence of device-related thrombus and an increased risk of late stroke or transient ischemic attack (TIA) after LAAC.
- LA SEC is a significant independent predictor of late stroke/TIA in this patient population.
Abstract:
Objectives: Spontaneous echo contrast (SEC) in the left atrium (LA) is frequently observed in atrial fibrillation (AF) patients and may lead to thromboembolic events. We aimed to investigate both periprocedural and long-term stroke risks associated with LA SEC in AF patients undergoing percutaneous left atrial appendage closure (LAAC). Methods: A total of 408 consecutive AF patients treated with LAAC between March 2015 and February 2019 were divided into two groups based on preprocedural transesophageal echocardiography: the study group (moderate/severe LA SEC; n = 41) and the control group (none, mild, or mild to moderate LA SEC; n = 367). To attenuate the observed imbalance in baseline covariates, a propensity score matching technique was used. Results: No periprocedural stroke/transient ischemic attack (TIA) was documented. The incidence of device-related thrombus was higher in the study group than in the control group (8.8 vs. 1.3%; P = 0.025). The mean follow-up period was 3.2 ± 1.1 years, during which 8 patients (2.2%) in the control group and 4 (9.8%) in the study group experienced stroke/TIA (P = 0.024). Moderate/severe LA SEC was identified as an independent predictor of stroke/TIA in both the original population (HR = 5.71, 95% CI 1.47-22.19, P = 0.012) and the matched population (HR = 9.79, 95% CI 1.44-66.86, P = 0.020). Conclusions: LA SEC did not show a relationship with periprocedural stroke events in patients undergoing percutaneous LAAC. However, moderate/severe LA SEC increased the incidence of device-related thrombus and the risk of late stroke/TIA.
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