Effective Therapeutic Intervention for Left Atrial Appendage Thrombus: Percutaneous Left Atrial Appendage Closure
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Keywords:Anticoagulants, atrial appendage, atrial fibrillation, catheterization closure devices, thrombosis
Objective: The thrombus formation in the left atrial appendage (LAA) can be challenging for operators and increases periprocedural complication risk. However, recent consensus documents discuss that left atrial appendage closure is a potential therapeutic option for malign left atrial appendage. This clinical study aimed to evaluate the procedural safety and early efficacy outcomes of left atrial appendage closure in patients with left atrial appendage thrombus.
Methods: This observational single-center clinical trial included 18 patients with left atrial appendage thrombus. Transesophageal echocardiography was performed before and during the left atrial appendage closure in all patients. All procedures were performed using the Amplatzer Amulet left atrial appendage closure device (Abbott Medical Inc.).
Results: Ten of the patients were male (55.6%). The mean ages were 69.6 ± 7.5 years. CHA2DS2-VASc and HAS-BLED scores were calculated at 5 (2-8) and 3 (1-6), respectively. In 4 patients (22.2%), left atrial appendage occlusion was indicated due to malign left atrial appendage. The significant bleeding event under oral anticoagulant treatment was the main indication in 12 patients (66.7%). All patients were referred to Transthoracic Echocardiography (TTE) and transesophageal echocardiography 30 days after the procedure. There were no major or minor adverse clinical events during the first month of follow-up. Also, no patient faced ischemic cerebrovascular events, including transient ischemic attack, hospitalization due to heart failure, or significant bleeding events. Neither device-related thrombus nor peridevice leak was observed in the Transesophageal echocardiography evaluation.
Conclusions: Left atrial appendage closure in patients with left atrial appendage thrombus is a feasible and effective method to reduce thromboembolic risk. It can be performed as an alternative therapy to oral anticoagulants (OACs) in patients with contraindications to OACs or malign left atrial appendage.
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021;42(5):373-498.
January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation. 2019;140(2):e125-e151.
Osmancik P, Herman D, Neuzil P, et al. Left atrial appendage closure versus direct oral anticoagulants in high-risk patients with atrial fibrillation. J Am Coll Cardiol. 2020;75(25):3122-3135.
Aytemir K, Aminian A, Asil S, et al. First case of percutaneous left atrial appendage closure by amulet™ device in a patient with left atrial appendage thrombus. Int J Cardiol. 2016;223:28-30.
Sahiner L, Coteli C, Kaya EB, et al. Left atrial appendage occlusion in patients with thrombus in left atrial appendage. J Invasive Cardiol. 2020;32(6):222-227.
Sharma SP, Cheng J, Turagam MK, et al. Feasibility of left atrial appendage occlusion in left atrial appendage thrombus: a systematic review. JACC Clin Electrophysiol. 2020;6(4):414-424.
Tzikas A, Holmes DR, Jr, Gafoor S, et al. Percutaneous left atrial appendage occlusion: the Munich consensus document on definitions, endpoints, and data collection requirements for clinical studies. Europace. 2017;19(1):4-15.
MichaelG, Rafael W, Gerhard H, et al. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion–an update. EuroIntervention. 2020;15(13):1133-1180.
Enomoto Y, Hara H, Makino K, et al. Usefulness of an isoproterenol infusion to differentiate a left atrial appendage thrombus in a patient with nonvalvular atrial fibrillation. Pacing Clin Electrophysiol. 2021;44(1):192-193.
Watson T, Shantsila E, Lip GY. Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited. Lancet. 2009;373(9658): 155-166.
Tarantini G, D’Amico G, Latib A, et al. Percutaneous left atrial appendage occlusion in patients with atrial fibrillation and left appendage thrombus: feasibility, safety and clinical efficacy. Euro-Intervention. 2018;13(13):1595-1602.
Boccuzzi GG, Montabone A, D'Ascenzo F, et al. Cerebral protection in left atrial appendage closure in the presence of appendage thrombosis. Catheter Cardiovasc Interv. 2021;97(3):511-515.
Limite LR, Radinovic A, Cianfanelli L, et al. Outcome of left atrial appendage closure using cerebral protection system for thrombosis: no patient left behind. Pacing Clin Electrophysiol. 2022;45(1):23-34.
Marroquin L, Tirado-Conte G, Pracoń R, et al. Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure. Heart. 2022;108(14):1098-1106.
Bellmann B, Rillig A, Leistner DM, et al. Left atrial appendage closure in a patient with left atrial appendage thrombus using a novel fish ball technique. Int J Cardiol. 2017;234:146-149.
Jalal Z, Iriart X, Dinet ML, et al. Extending percutaneous left atrial appendage closure indications using the AMPLATZER™ Cardiac Plug device in patients with persistent left atrial appendage thrombus: the thrombus trapping technique. Arch Cardiovasc Dis. 2016;109(12):659-666.
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