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Updated: Jun 5, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Impact of intensive versus nonintensive antithrombotic treatment on device-related thrombus after left atrial
Philippe Garot1, Pedro Cepas-Guillén2, Eduardo Flores-Umanzor3
1Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France.
Insights
Suboptimal device implantation after left atrial appendage closure (LAAC) increases device-related thrombus (DRT) risk. Optimal implantation shows low DRT rates regardless of intensive or nonintensive antithrombotic therapy (AT).
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Research
Background:
- Optimal antithrombotic therapy (AT) post-left atrial appendage closure (LAAC) remains debated.
- Device-related thrombus (DRT) is a significant complication after LAAC.
Purpose of the Study:
- To evaluate the impact of intensive versus nonintensive AT on DRT incidence.
- To assess this impact based on the quality of LAAC device implantation (optimal vs. suboptimal).
Main Methods:
- 1225 patients undergoing LAAC were analyzed.
- Implantation quality: optimal (proximal, <3mm leak) vs. suboptimal (distal, ≥3mm leak).
- AT strategies: intensive (dual therapy) vs. nonintensive (single or no therapy).
Main Results:
- Suboptimal implantation was associated with a 4.51-fold increased risk of DRT (P<.001).
- DRT incidence was 2.6% (intensive AT) vs. 3.7% (nonintensive AT) in optimal implantations (P=.38).
- DRT incidence was 11.2% (intensive AT) vs. 15.5% (nonintensive AT) in suboptimal implantations (P=.19).
Conclusions:
- Suboptimal LAAC device implantation is an independent predictor of DRT.
- In optimal implantations, DRT rates were low and similar across AT strategies.
- Further randomized trials are needed to confirm these findings.
Introduction And Objectives:
The optimal antithrombotic therapy (AT) after left atrial appendage closure (LAAC) is debated. We assessed the impact of intensive vs nonintensive AT on the incidence of device-related thrombus (DRT) based on whether the device implantation was classified as optimal or suboptimal.
Methods:
This study included patients who underwent successful LAAC in 9 centers. Patients were classified according to the quality of device implantation: optimal (proximal implant without ≥3mm peridevice leak) or suboptimal (distal implant and/or ≥3mm peridevice leak). Postimplant AT was classified as either intensive (dual antiplatelet therapy, anticoagulants, or a combination of both) or nonintensive (no AT or a single antiplatelet therapy). The primary endpoint was the incidence of DRT between the 6th and 12th weeks postprocedure.
Results:
A total of 1225 patients underwent LAAC, with 757 (61.8%) achieving optimal device implantation and 468 (38.2%) classified as suboptimal. After a median follow-up of 20 months, the incidence of DRT in the optimal implant group was 2.6% with intensive AT and 3.7% with nonintensive AT (P=.38). In the suboptimal implant group, the incidence of DRT increased to 11.2% with intensive AT and 15.5% with nonintensive AT (P=.19). On multivariate analysis, suboptimal implantation (HR, 4.51; 95%CI, 2.70-7.54, P<.001) but not intensive AT (HR, 0,66; 95%CI, 0.40-1.07, P=.09) emerged as an independent predictor of DRT.
Conclusions:
The incidence of DRT after LAAC was higher in patients with suboptimal device implantation. In patients with optimal implantation, the incidence of DRT was low and similar between nonintensive and intensive AT strategies. Large, randomized trials are warranted to confirm these results.
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