Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Nov 27;16(22):2722-2732.
doi: 10.1016/j.jcin.2023.09.017.

Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes

Jules Mesnier  1 , Trevor Simard  2 , Richard G Jung  3 , Kyle R Lehenbauer  4 , Kerstin Piayda  5 , Radoslaw Pracon  6 , Gregory G Jackson  7 , Eduardo Flores-Umanzor  8 , Laurent Faroux  1 , 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 Agarwal  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  38 , Rashaad Chothia  30 , Jung-Sun Kim  29 , Armando Pérez de Prado  28 , Raveen Bazaz  39 , Dhiraj Gupta  26 , Miguel Valderrábano  25 , Carlos E Sanchez  24 , Mikhael F El Chami  23 , Patrizio Mazzone  40 , Marianna Adamo  21 , Fred Ling  20 , Dee Dee Wang  41 , William O'Neill  41 , Wojtek Wojakowski  18 , Ashish Pershad  17 , Sergio Berti  15 , Daniel B Spoon  14 , Akram Kawsara  13 , George Jabbour  12 , Lucas V A Boersma  11 , Boris Schmidt  10 , Jens Erik Nielsen-Kudsk  9 , Xavier Freixa  8 , Christopher R Ellis  7 , Laurent Fauchier  42 , Marcin Demkow  6 , Horst Sievert  27 , Michael L Main  4 , Benjamin Hibbert  3 , David R Holmes Jr  2 , Mohamad Alkhouli  43 , Josep Rodés-Cabau  44
Affiliations
Multicenter Study

Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes

Jules Mesnier et al. JACC Cardiovasc Interv. .

Abstract

Background: Scarce data exist on the evolution of device-related thrombus (DRT) after left atrial appendage closure (LAAC).

Objectives: This study sought to assess the incidence, predictors, and clinical impact of persistent and recurrent DRT in LAAC recipients.

Methods: Data were obtained from an international multicenter registry including 237 patients diagnosed with DRT after LAAC. Of these, 214 patients with a subsequent imaging examination after the initial diagnosis of DRT were included. Unfavorable evolution of DRT was defined as either persisting or recurrent DRT.

Results: DRT resolved in 153 (71.5%) cases and persisted in 61 (28.5%) cases. Larger DRT size (OR per 1-mm increase: 1.08; 95% CI: 1.02-1.15; P = 0.009) and female (OR: 2.44; 95% CI: 1.12-5.26; P = 0.02) were independently associated with persistent DRT. After DRT resolution, 82 (53.6%) of 153 patients had repeated device imaging, with 14 (17.1%) cases diagnosed with recurrent DRT. Overall, 75 (35.0%) patients had unfavorable evolution of DRT, and the sole predictor was average thrombus size at initial diagnosis (OR per 1-mm increase: 1.09; 95% CI: 1.03-1.16; P = 0.003), with an optimal cutoff size of 7 mm (OR: 2.51; 95% CI: 1.39-4.52; P = 0.002). Unfavorable evolution of DRT was associated with a higher rate of thromboembolic events compared with resolved DRT (26.7% vs 15.1%; HR: 2.13; 95% CI: 1.15-3.94; P = 0.02).

Conclusions: About one-third of DRT events had an unfavorable evolution (either persisting or recurring), with a larger initial thrombus size (particularly >7 mm) portending an increased risk. Unfavorable evolution of DRT was associated with a 2-fold higher risk of thromboembolic events compared with resolved DRT.

Keywords: atrial fibrillation; device-related thrombus; left atrial appendage occlusion; stroke.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures Dr Rodés-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions (Laval University, Quebec City, Canada). He also has received institutional research grants from Boston Scientific. 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 Wang has served as a consultant for Edwards Lifesciences, Boston Scientific, and Neochord; and received research grant support from Boston Scientific assigned to his employer, the Henry Ford Health System. Dr Demkow has served as a proctor for Abbott and Boston Scientific. Dr Alkhouli has served as a consultant for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

Publication types