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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Long-Term Clinical Outcomes of Left Atrial Appendage Closure in Patients with Left Atrial Appendage Thrombus
Moshe Katz1,2, Rotem Nahmias Oz1, Eias Massalha1,2
1Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel.
Insights
Left atrial appendage closure (LAAC) is a safe option for atrial fibrillation patients with left atrial appendage (LAA) thrombus. Long-term outcomes for LAAC with LAA thrombus are comparable to those without thrombus.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Left atrial appendage closure (LAAC) is an alternative for atrial fibrillation (AF) patients unsuitable for anticoagulation.
- Left atrial appendage (LAA) thrombus is typically a contraindication for LAAC.
- Limited long-term data exists for LAAC in patients with LAA thrombus.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of LAAC in AF patients with LAA thrombus.
- To compare outcomes between patients with and without LAA thrombus undergoing LAAC.
Main Methods:
- Retrospective, single-center registry of AF patients undergoing LAAC (June 2010 - April 2024).
- Patients stratified by presence or absence of LAA thrombus.
- Primary endpoint: 5-year composite of stroke, systemic embolism, or all-cause mortality.
Main Results:
- 24 (6%) of 403 patients had LAA thrombus.
- Median follow-up: 3.9 years.
- No significant difference in the primary endpoint or MACE between thrombus and no-thrombus groups (log-rank p = 0.862).
Conclusions:
- LAAC can be safely performed in selected AF patients with distal LAA thrombus.
- Long-term outcomes are comparable to patients without LAA thrombus.
- LAAC offers a viable option for high-risk AF patients with LAA thrombus.
Abstract:
Background: Patients with atrial fibrillation (AF) who have a high bleeding risk or contraindications to anticoagulation may be candidates for left atrial appendage closure (LAAC). However, the presence of a thrombus in the left atrial appendage (LAA) is generally considered a contraindication to the procedure. While the feasibility and short-term safety of LAAC in patients with pre-existing LAA thrombus has been reported, data on long-term outcomes remain limited. Objective: To assess the long-term clinical outcomes of AF patients undergoing LAAC in the presence of an LAA thrombus. Methods: This retrospective, single-center registry included all AF patients who underwent LAAC between June 2010 and April 2024. Patients were stratified based on the presence or absence of LAA thrombus at the time of the procedure. The primary endpoint was a 5-year composite of stroke, systemic embolism, or all-cause mortality. Results: A total of 403 patients underwent LAAC, of whom 24 (6%) had an LAA thrombus at the time of the procedure. During a median follow-up of 3.9 years, the primary endpoint occurred in 116 patients: 110 events (41%) in the no-thrombus group and 6 events (38%) in the thrombus group. There was no statistically significant difference in major adverse cardiovascular events (MACE) between groups (log-rank p = 0.862). Conclusions: LAAC may be performed safely in selected patients with distal LAA thrombus, with long-term outcomes comparable to those without thrombus.
