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Updated: Aug 19, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Impact and predictors of device-related thrombus after percutaneous left atrial appendage closure
Luca Branca1, Daniela Tomasoni, Giuliana Cimino
1Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Insights
Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is a concern, especially for patients ineligible for anticoagulation. This review highlights DRT
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis
Background:
- Device-related thrombus (DRT) complicates up to 7% of percutaneous left atrial appendage closure (LAAC) procedures.
- LAAC patients often have contraindications to oral anticoagulation, making DRT a significant clinical concern.
- Understanding DRT's impact on outcomes is crucial for this patient population.
Approach:
- This review synthesizes current evidence on DRT following LAAC.
- It examines the association between DRT and patient outcomes, particularly neurological events.
- The review also explores potential predictors and preventive strategies for DRT.
Key Points:
- A stronger link exists between DRT and ischemic neurological events.
- Post-LAAC antithrombotic strategies may reduce DRT incidence.
- Patient and procedural factors are identified as potential DRT predictors.
Conclusions:
- DRT is a critical complication of LAAC with potential neurological sequelae.
- Antithrombotic therapy and careful patient selection/follow-up are key to managing DRT risk.
- A personalized approach is necessary for LAAC patient management.
Abstract:
Device-related thrombus (DRT) is a known complication occurring in up to 7% of patients undergoing percutaneous left atrial appendage closure (LAAC). Since the target population of LAAC is generally ineligible for oral anticoagulant therapies, DRT raises important concerns. The aim of this review will be to summarize available evidence on DRT after LAAC focusing on its possible impact on outcomes. Recent findings showed a tighter association between DRT and neurological ischemic events. Antithrombotic regimen adopted after LAAC may have a protective effect against DRT. Many patient-related and procedural factors have been identified as possible predictors of DRT. A tailored approach, which takes into account DRT, is needed in the patient selection for LAAC and in the postprocedural follow-up.
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