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Updated: Jul 27, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

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Symptomatic vs. non-symptomatic device-related thrombus after LAAC: a sub-analysis from the multicenter EUROC-DRT

Vivian Vij1, Ignacio Cruz-González2, Roberto Galea3

  • 1Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|June 9, 2023
PubMed

Insights

Device-related thrombus (DRT) after left atrial appendage closure (LAAC) poses a significant risk for stroke or systemic embolism (SE). Identifying predictors for these events in DRT patients is crucial for improving patient outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Thrombosis Research

Background:

  • Device-related thrombus (DRT) following left atrial appendage closure (LAAC) is linked to adverse events like ischemic stroke and systemic embolism (SE).
  • Limited data exists on the predictors of stroke/SE specifically in patients who develop DRT after LAAC.

Purpose of the Study:

  • To identify predisposing factors for stroke/SE in patients diagnosed with DRT after LAAC.
  • To analyze the temporal relationship between stroke/SE events and the diagnosis of DRT.

Main Methods:

  • The EUROC-DRT registry, comprising 176 patients with DRT post-LAAC, was analyzed.
  • Patients with symptomatic DRT (stroke/SE occurring with DRT diagnosis) were compared to those with asymptomatic DRT.
  • Baseline characteristics, anti-thrombotic strategies, device positioning, and event timing were assessed.

Main Results:

  • 14.2% of patients (25/176) with DRT experienced stroke/SE (symptomatic DRT).
  • Stroke/SE occurred at a median of 198 days post-LAAC, with 45.8% occurring within one month of DRT diagnosis.
  • Symptomatic DRT patients showed lower ejection fractions and higher rates of non-paroxysmal atrial fibrillation; event timing varied, and occurred across different anti-thrombotic regimens.

Conclusions:

  • Stroke/SE events in DRT patients occur both temporally related to DRT diagnosis and independently.
  • Identifying specific risk factors for stroke/SE in DRT patients remains challenging, indicating a substantial risk for all such patients.
  • Further research is needed to develop strategies for minimizing the risk of DRT and subsequent ischemic events.
Abstract

Keywords:
Atrial fibrillationDevice-related thrombusLeft atrial appendage closureStroke

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