Unsuccessful percutaneous left atrial appendage occlusion: A single center perspective

Epicardial and endocardial left atrial appendage occlusion (LAAO) is commonly performed for stroke prevention for atrial fibrillation (AF) patients at increased risk for stroke who cannot tolerate long-term oral anticoagulation. However, there is limited data on the outcomes of unsuccessful LAAO procedures. This study aims to assess the incidence and outcomes of unsuccessful LAAO procedures.

A retrospective analysis was performed on patients undergoing LAAO at our institution from 2020 to 2023. The primary endpoint was a failure to deploy the LAAO device, which was defined as unsuccessful device implantation (UDI).

A total of 411 patients underwent LAAO (Lariat = 6.8%, Amulet = 56.4%, and Watchman FLX/FLX Pro = 36.7%). UDI was observed in 4.9% (n = 20) of procedures. The cohort's mean age was 77.1 ± 10 years, and 45% were males. The mean CHA₂DS₂-VASc score was 4 ± 1.7, and the HASBLED score was 3.2 ± 1.4. The highest UDI rate was seen in Lariat (17.9%), followed by Watchman FLX (4.6%) and Amulet (2.2%). The primary reasons for UDI were unsatisfactory device positioning, inadequate depth attainment, anatomical incompatibility, and trabeculations impeding proper device placement. Among those with UDI, 40% underwent subsequent LAA closure using AtriClip, while the remainder continued oral anticoagulant as destination therapy. A small number had post-procedural complications.

LAAO demonstrates a low failure rate and is generally safe. LAA morphology significantly influences the procedure's success, with AtriClip surgical exclusion often serving as an option after UDI.