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Multicenter Study
. 2021 Jul 27;78(4):297-313.
doi: 10.1016/j.jacc.2021.04.098.

Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

Trevor Simard  1 , Richard G Jung  2 , Kyle Lehenbauer  3 , Kerstin Piayda  4 , Radoslaw Pracoń  5 , Gregory G Jackson  6 , Eduardo Flores-Umanzor  7 , Laurent Faroux  8 , Kasper Korsholm  9 , Julian K R Chun  10 , Shaojie Chen  10 , Moniek Maarse  11 , Kristi Montrella  12 , Zakeih Chaker  13 , Jocelyn N Spoon  14 , Luigi E Pastormerlo  15 , Felix Meincke  16 , Abhishek C Sawant  17 , Carmen M Moldovan  18 , Mohammed Qintar  19 , Mehmet K Aktas  20 , Luca Branca  21 , Andrea Radinovic  22 , Pradhum Ram  23 , Rayan S El-Zein  24 , Thomas Flautt  25 , Wern Yew Ding  26 , Bassel Sayegh  27 , Tomás Benito-González  28 , Oh-Hyun Lee  29 , Solomon O Badejoko  30 , Christina Paitazoglou  31 , Nabeela Karim  32 , Ahmed M Zaghloul  33 , Himanshu Agrawal  34 , Rachel M Kaplan  35 , Oluseun Alli  36 , Aamir Ahmed  37 , Hussam S Suradi  37 , Bradley P Knight  35 , Venkata M Alla  34 , Sidakpal S Panaich  33 , Tom Wong  32 , Martin W Bergmann  31 , Rashaad Chothia  30 , Jung-Sun Kim  29 , Armando Pérez de Prado  28 , Raveen Bazaz  38 , Dhiraj Gupta  26 , Miguel Valderrabano  25 , Carlos E Sanchez  24 , Mikhael F El Chami  23 , Patrizio Mazzone  22 , Marianna Adamo  21 , Fred Ling  20 , Dee Dee Wang  19 , William O'Neill  19 , Wojtek Wojakowski  18 , Ashish Pershad  17 , Sergio Berti  15 , Daniel Spoon  14 , Akram Kawsara  13 , George Jabbour  12 , Lucas V A Boersma  11 , Boris Schmidt  10 , Jens Erik Nielsen-Kudsk  9 , Josep Rodés-Cabau  8 , Xavier Freixa  7 , Christopher R Ellis  6 , Laurent Fauchier  39 , Marcin Demkow  5 , Horst Sievert  40 , Michael L Main  3 , Benjamin Hibbert  2 , David R Holmes Jr  41 , Mohamad Alkhouli  42
Affiliations
Free article
Multicenter Study

Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

Trevor Simard et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited.

Objectives: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT.

Methods: Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT.

Results: A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors.

Conclusions: DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.

Keywords: ACP; Amplatzer cardiac plug; Amulet; DRT; LAAO; Watchman; Watchman FLX; device-related thrombus; left atrial appendage occlusion.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Maarse has received an unrestricted grant from Boston Scientific. Dr Pérez de Prado has served as a proctor for Boston Scientific. Dr Gupta has served as a proctor for Abbott. Dr Sanchez has served as a speaker and proctor for Boston Scientific. Dr Demkow has served as a proctor for Abbott and Boston Scientific. Dr Alkhouli has served as a consultant for Boston Scientific. Dr Wang has been a consultant for Edwards LifeSciences, Boston Scientific, and Neochord; and has received research grant support from Boston Scientific assigned to employer Henry Ford health system. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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