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Updated: Aug 28, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Clinical relevance of incomplete device endothelialization after left atrial appendage closure
Jing Xu1, Chuan Zhi Chen2, Jun Xing2
1Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Ji Mo Rd, 200120, Shanghai, China.
Insights
Incomplete device endothelialization (IDE) is common after left atrial appendage closure (LAAC), particularly in patients with persistent AF. While IDE increases the risk of device-related thrombus (DRT), it may not lead to adverse clinical outcomes with proper monitoring.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- Left atrial appendage closure (LAAC) is an alternative to anticoagulation for stroke prevention in nonvalvular atrial fibrillation (AF).
- Incomplete device endothelialization (IDE) is a potential complication following LAAC, with unclear clinical significance.
Purpose of the Study:
- To determine the incidence, risk factors, and clinical impact of IDE after LAAC.
- To evaluate the association between IDE and device-related thrombus (DRT) and major adverse cardio-cerebral events (MACCE).
Main Methods:
- Prospective follow-up of 101 patients undergoing LAAC for up to 6 months.
- Cardiac computed tomography (CT) used to assess device endothelialization and DRT.
- Recording of MACCE, including death, heart failure hospitalization, stroke, TIA, embolism, and bleeding.
Main Results:
- IDE was observed in 64.4% of patients.
- Independent risk factors for IDE included persistent AF, larger left atrial appendage ostial diameter, and larger left atrial size.
- DRT incidence was 4.6% in the IDE group vs. 2.8% in the complete endothelialization group (p > 0.05); MACCE rates were also non-significantly higher in the IDE group (7.7% vs. 2.8%, p = 0.32).
Conclusions:
- IDE is a frequent finding after LAAC, particularly in patients with specific anatomical and rhythm characteristics.
- IDE is associated with an increased risk of DRT but not necessarily with adverse thromboembolic events or poor clinical outcomes.
- Close monitoring and continued antithrombotic therapy are crucial for patients with IDE after LAAC.
Purpose:
This study aimed to assess the incidence, potential risk factors and clinical impact of incomplete device endothelialization(IDE) after left atrial appendage closure (LAAC).
Methods:
A total of 101 consecutive patients with nonvalvular atrial fibrillation (AF) who underwent successful LAAC and received antithrombotic treatment using a standard regimen were prospectively followed up to 6 months after the procedure. The status of device endothelialization and device-related thrombus (DRT) were evaluated using cardiac computed tomography (CT). Major adverse cardio-cerebral events (MACCE) including all-cause death, heart failure(HF) hospitalization, acute ischemic stroke, transient ischemic attack(TIA), peripheral vascular embolism, and major bleeding were recorded.
Results:
IDE was detected in 65 (64.4%) patients. Patients with IDE or complete device endothelialization (CDE) did not significantly differ with respect to baseline clinical characteristics and interventional procedure features. Multivariate analysis model revealed that persistent AF, left atrial appendage ostial diameter and left atrial size were independent risk factors for IDE. During 6-month follow-up, the incidence of DRT was 4.6% in patients with IDE and 2.8% in those with CDE, respectively (p > 0.05), and the overall rate of MACCE was non-significantly higher in the IDE group (7.7% vs. 2.8%, p = 0.32).
Conclusion:
IDE is common after LAAC, especially in patients with persistent AF, higher left atrial appendage ostial diameter and left atrial size. IDE confers an increased risk for DRT, but may be not necessarily associated with thromboembolic events and poor clinical outcome, providing careful monitoring and continued antithrombotic therapy are given.
