Related Experiment Video
Updated: Sep 4, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Clinical and echocardiographic risk factors for device-related thrombus after left atrial appendage closure: an
Vivian Vij1, Kerstin Piayda2, Dominik Nelles1
1Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Insights
Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) is linked to adverse events. Key risk factors include patient history of stroke/TIA, spontaneous echocardiographic contrast, and device implantation depth.
Area of Science:
- Cardiology
- Medical Devices
- Thrombosis
Background:
- Device-related Thrombus (DRT) following left atrial appendage closure (LAAC) is not well-documented.
- Limited data exists on risk factors for DRT post-LAAC.
Purpose of the Study:
- To investigate the risk factors associated with Device-related Thrombus (DRT) after left atrial appendage closure (LAAC).
- To identify patient and procedural characteristics that predict DRT development.
Main Methods:
- Analysis of 537 patients undergoing LAAC, comparing 112 with DRT to 425 without.
- Inclusion of baseline, implantation characteristics, anti-thrombotic treatment, and outcomes.
- Utilized univariate, multivariate, and propensity-score matching (PSM) analyses.
Main Results:
- DRT patients had higher rates of prior stroke/TIA, spontaneous echocardiographic contrast (SEC), and lower LAA peak emptying velocity.
- Larger occluders, deeper implantation, and less ostium coverage were observed in DRT patients.
- Independent risk factors identified: age, prior stroke/TIA, SEC; PSM highlighted implantation depth. DRT patients experienced higher stroke/TIA rates.
Conclusions:
- Device-related Thrombus (DRT) after LAAC is associated with poor clinical outcomes.
- DRT appears multifactorial, influenced by patient characteristics, anticoagulation, and device placement.
- Identifying and mitigating these risk factors is crucial for improving LAAC safety and efficacy.
Background:
Data on Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) remain scarce. This study aimed to investigate risk factors for DRT from centers reporting to the EUROC-DRT registry.
Methods:
We included 537 patients (112 with DRT and 425 without DRT) who had undergone LAAC between 12/2008 and 04/2019. Baseline and implantation characteristics, anti-thrombotic treatment and clinical outcomes were compared between both groups in uni- and multivariate analyses. Additional propensity-score matching (PSM) was conducted to focus on the role of implantation characteristics.
Results:
Patients with DRT showed higher rates of previous stroke/transient ischemic attack (TIA) (49.1% vs. 34.7%, p < 0.01), spontaneous echocardiographic contrast (SEC) (44.9% vs. 27.7%, p < 0.01) and lower left atrial appendage (LAA) peak emptying velocity (35.4 ± 18.5 vs. 42.4 ± 18.0 cm/s, p = 0.02). Occluders implanted in DRT patients were larger (25.5 ± 3.8 vs. 24.6 ± 3.5 mm, p = 0.03) and implanted deeper in the LAA (mean depth: 7.6 ± 4.7 vs. 5.7 ± 4.7 mm, p < 0.01). Coverage of the appendage ostium was achieved less often in DRT patients (69.5% vs. 81.5%, p < 0.01), while DRT patients were less frequently on oral anticoagulation (7.1% vs. 16.7%, p < 0.01). Multivariate analysis identified age, prior stroke/TIA and SEC as independent risk factors for DRT. After PSM, implantation depth was found to be predictive. Rates of stroke/TIA were higher in DRT patients (13.5% vs. 3.8%, Hazard Ratio: 4.21 [95%-confidence interval: 1.88-9.49], p < 0.01).
Conclusions:
DRT after LAAC is associated with adverse outcome and appears to be of multifactorial origin, depending on patient characteristics, anticoagulation regimen and device position.
Related Concept Videos
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:21Cardiac Catheterization II: Right Heart Catheterization