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. 2020 Dec 14;6(13):1687-1697.
doi: 10.1016/j.jacep.2020.07.003. Epub 2020 Sep 16.

Impact of Left Atrial Appendage Closure on LAA Thrombus Formation and Thromboembolism After LAA Isolation

Thomas Fink  1 , Julia Vogler  2 , Christian-Hendrik Heeger  3 , Makoto Sano  2 , Vanessa Sciacca  3 , Bruno Reissmann  4 , Peter Wohlmuth  5 , Ahmad Keelani  2 , Christopher Schütte  4 , Charlotte Eitel  2 , Ingo Eitel  6 , Tilman Maurer  4 , Laura Rottner  4 , Andreas Rillig  4 , Shibu Mathew  4 , Andreas Metzner  4 , Feifan Ouyang  7 , Karl-Heinz Kuck  8 , Roland Richard Tilz  8
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Free article

Impact of Left Atrial Appendage Closure on LAA Thrombus Formation and Thromboembolism After LAA Isolation

Thomas Fink et al. JACC Clin Electrophysiol. .
Free article

Abstract

Objectives: This study sought to evaluate the safety and effectiveness of electrical isolation of the left atrial appendage (LAAEI) as well as the status of left atrial appendage closure (LAAC) in these patients.

Background: Catheter-based LAAEI is increasingly performed for treatment of symptomatic atrial fibrillation and pulmonary vein isolation nonresponders. Previous studies indicate an increased incidence of thromboembolic events after LAAEI despite effective oral anticoagulation. Interventional LAAC may prevent cardioembolic events after LAAEI but data regarding safety, feasibility, and efficacy of LAAC in this clinical setting are scarce.

Methods: Consecutive patients who underwent LAAEI at 2 German tertiary care hospitals were analyzed.

Results: A total of 270 patients underwent LAAEI by radiofrequency ablation in 255 (94.4%), cryoballoon ablation in 12 (4.4%), and by a combination of both techniques in 3 cases (1.1%). Stroke or transient ischemic attack occurred in 24 of 244 (9.8%) individuals with available follow-up. LAA thrombus formation was found in 53 patients (19.6%). A total of 150 patients underwent LAAC after LAAEI. No LAA thrombus was documented in any patient who underwent LAAC. Of the patients who underwent LAAEI, 67.6% were in sinus rhythm after a mean of 682.7 ± 61.7 days. LAA flow after LAAEI but not arrhythmia recurrence was identified as an independent predictor of stroke and/or transient ischemic attack or LAA thrombus (p < 0.0001).

Conclusions: Sinus rhythm was documented in about two-third of patients undergoing LAAEI as treatment of therapy refractory atrial arrhythmias. LAAC potentially prevents LAA thrombus formation and thromboembolism.

Keywords: arrhythmia recurrence; atrial fibrillation; catheter ablation; left atrial appendage closure; left atrial appendage isolation; left atrial thrombus; stroke.

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Conflict of interest statement

Author Disclosures Dr. Fink received travel grants from SentreHeart. Dr. Heeger has received travel grants and research grants from Medtronic, Claret Medical, SentreHeart, Biosense Webster, and Cardiofocus; and has received speaker honoraria from Cardiofocus, Medtronic, and Novartis. Dr. Eitel has received speaker honoraria from Bayer, Biosense Webster, Impulse Dynamic, St. Jude Medical/Abbott, Pfizer, Liva Nova, Zoll, Boston Scientific, Novartis, Daiichi Sankyo, and AstraZeneca; and has received travel grants from St. Jude Medical, Biotronik, and Medtronic. Dr. Rillig has received travel grants from Biosense, Hansen Medical, EP Solutions, Medtronic, and St. Jude Medical; has received lecture fees from St. Jude Medical, Medtronic, and Boehringer Ingelheim; and took part in the Boston Scientific electrophysiology fellowship. Dr. Mathew has received speaker honoraria and travel grants from Medtronic. Dr. Metzner has received speaker honoraria and travel grants from Medtronic. Prof. Kuck received research grants and personal fees from St. Jude Medical, Medtronic, and Biosense Webster. Prof. Tilz has received research grants from Medtronic and Biotronik; received travel grants from Biosense Webster, Medtronic, Abbott, SentreHeart, and Daiichi Sankyo; received Speakers Bureau and/or proctor honoraria from Biosense Webster, Medtronic, Abbott, SentreHeart, and Daiichi Sankyo; and has served as a consultant of Biosense Webster and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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