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Updated: Aug 14, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
An updated meta-analysis of device related thrombus following left atrial appendage closure in patients with atrial
Song Zhang1, Si-Huai Xiong1, Yu-Gen Guan1
1Department of Cardiovasology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China.
Insights
Device related thrombus (DRT) following left atrial appendage closure (LAAC) is uncommon and similar between single-seal and dual-seal devices. However, DRT significantly increases the risk of ischemic stroke and systemic embolism.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Device related thrombus (DRT) is a recognized complication of left atrial appendage closure (LAAC).
- The association between DRT and the risk of ischemic events remains debated.
- This study reassesses DRT incidence and its link to ischemic stroke and systemic embolism (SE) using recent clinical trial data.
Approach:
- A systematic literature search was conducted across PubMed, Embase, and Cochrane Library up to April 2022.
- 59 eligible studies were analyzed to determine DRT incidence and compare stroke/SE rates in DRT versus non-DRT patients.
- Subgroup analysis compared DRT rates between single-seal (SS) and dual-seal (DS) devices.
Key Points:
- The overall incidence of DRT was 2.8% (366/12,845), with no significant difference between SS and DS devices (2.8% vs. 3.6%, p=0.93).
- DRT was associated with a significantly higher pooled incidence of stroke (11.5% vs. 2.9%, OR=5.08) and SE (sensitivity analysis: 16.0% vs. 3.8%, OR=4.48).
- The occurrence rate of ischemic events related to DRT was comparable between SS and DS devices.
Conclusions:
- DRT incidence following LAAC is low and consistent across different device types.
- DRT is a significant risk factor for subsequent ischemic stroke and systemic embolism.
- The risk of ischemic events associated with DRT does not differ based on the occlusion mechanism device (SS vs. DS).
Aims:
Device related thrombus (DRT) is a known complication of left atrial appendage closure (LAAC). However, the relation between DRT and elevated risk of ischemic events remains controversial. This study is sought to reassessed the incidence of DRT following LAAC and the relation between DRT and elevated risk of ischemic stroke and systemic embolism (SE) with latest clinical trials included.
Methods:
The PubMed, Embase, and Cochrane Library databases were systematically searched from their inception until April 2022 for studies that reported the incidence of DRT and compared the incidence of both stroke and SE between DRT patients and non-DRT patients.
Results:
In 59 eligible studies, the incidence of DRT was 366/12,845 (2.8%, ranging from 0 to 11%, I 2 = 64%). The incidence of DRT was not statistically different between single-seal device (SS) and dual-seal device (DS) in subgroup analysis [171/6,190 (2.8%) vs. 78/3,023 (3.6%); p = 0.93]. The pooled incidence of stroke (26 studies, 7,827 patients) in patients with and without DRT was 11.5% in DRT patients and 2.9% among non-DRT patients (OR: 5.08; 95% CI = 3.47-7.44). In the sensitivity analysis, DRT was associated with higher rate of stroke (12.1 vs. 3.2%; OR: 4.14; 95% CI = 2.69-6.38) and SE (16.0 vs. 3.8%; OR: 4.48; 95% CI = 3.04-6.62).
Conclusion:
The incidence of DRT was low and similar between SS and DS devices. DRT was associated with increased rates of ischemic events. The occurrence rate of ischemic events associated DRT was comparable between two occlusion mechanism devices.
Systematic Review Registration:
[https://www.crd.york.ac.uk/], identifier [CRD42022326179].
