Procedural Outcome and Long-Term Follow-Up of Patients Undergoing Epicardial or Endocardial Left Atrial Appendage...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Technology

Background:

• Left atrial appendage (LAA) closure is crucial for high-risk atrial fibrillation patients to prevent stroke.
• Endocardial LAA closure is common, while epicardial ligation offers potential anticoagulation benefits.
• Comparative analysis of these LAA occlusion techniques is needed for clinical decision-making.

Purpose of the Study:

• To retrospectively compare the efficacy, safety, and long-term outcomes of endocardial versus epicardial LAA occlusion.
• To evaluate procedural characteristics and complication rates associated with each LAA closure method.

Main Methods:

• Retrospective analysis of 112 patients undergoing LAA occlusion from November 2018 to August 2024.
• Comparison between 69 patients with epicardial LAA ligation (Lariat®) and 43 patients with endocardial LAA plug (Amulet™).
• Assessment of procedural time, fluoroscopy time, silent cerebral lesions (SCLs), thrombus formation, gaps, and peridevice leaks (PDLs) at 3 and 12 months.

Main Results:

• Epicardial ligation had significantly longer procedure and fluoroscopy times.
• Silent cerebral lesions were similarly distributed (11.0% vs. 8%).
• Early follow-up showed more thrombi with epicardial ligation (8% vs. 0%) and more PDLs with endocardial closure (1% vs. 16%); these resolved by 12 months, with comparable long-term outcomes.

Conclusions:

• Epicardial LAA ligation is associated with longer procedural times compared to endocardial closure.
• Both methods have distinct early complications (thrombi for epicardial, PDLs for endocardial) that appear manageable.
• Long-term clinical results for both endocardial and epicardial LAA occlusion techniques are comparable.