Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and...

Area of Science:

• Cardiology
• Medical Devices
• Thrombosis Research

Background:

• Limited data exist on the long-term outcomes of device-related thrombus (DRT) following left atrial appendage closure (LAAC).
• Understanding DRT evolution is crucial for managing patients undergoing LAAC procedures.

Purpose of the Study:

• To determine the incidence, predictors, and clinical significance of persistent and recurrent DRT after LAAC.
• To identify factors associated with unfavorable DRT evolution and its impact on thromboembolic events.

Main Methods:

• Analysis of an international multicenter registry of 237 patients with DRT post-LAAC.
• Inclusion of 214 patients with follow-up imaging to assess DRT evolution (persistent or recurrent).
• Statistical analysis to identify predictors of persistent DRT and unfavorable DRT evolution.

Main Results:

• DRT resolved in 71.5% of cases; persistence occurred in 28.5%.
• Larger initial DRT size (>7mm) and female sex predicted persistent DRT.
• Unfavorable DRT evolution was observed in 35% of patients, with initial thrombus size >7mm being a significant predictor.
• Unfavorable DRT evolution was linked to a 2-fold increased risk of thromboembolic events.

Conclusions:

• Approximately one-third of DRT cases after LAAC show unfavorable evolution (persistence or recurrence).
• Initial thrombus size, particularly >7mm, is a key predictor of unfavorable DRT evolution.
• Unfavorable DRT evolution significantly increases the risk of thromboembolic events, highlighting the need for close monitoring.