Left Atrial Appendage Patency at Cardioversion After Surgical Left Atrial Appendage Intervention

Abstract

Surgical closure of the LAA is often incomplete. Interrogation of the residual LAA after surgical LAA intervention with TEE before DCCV frequently detects thrombus and alters clinical management. Patients undergoing DCCV after surgical LAA intervention require evaluation with TEE for LAA patency and thrombus.

Impact of anticoagulation strategy after left atrial appendage occlusion in patients requiring direct current cardioversion

“…In this case, TOE excluded cardiac thrombi before DCCV, but a small peri‐device leak was seen and an association was suggested. Another study evaluating safety of DCCV in patients after surgical closure of the LAA described the association of higher prevalence of thrombi in incomplete closure of the LAA 16 . On the contrary, in our study no TE events occurred, in spite of the fact that 40% of patients had peri‐device leakage and 55/150 DCCVs (37%) in those patients were performed without guideline recommended OAT.…”

Intraoperative transesophageal echocardiography is essential for left atrial appendage closure

“…Previously, Cullen et al 6 retrospectively reviewed TEE data on 93 patients undergoing cardioversion within 30 days of surgical LAA ligation. The authors found iSLC in 37% of the patients, similar to the current literature.…”

The electrophysiologic basis for lesions of the contemporary Maze operation

“…It can be amputated, but thrombosis of the suture line postoperatively is not uncommon after LAA amputation. 11 Some prefer to close it with a stapling device, but the first randomized, control trial of this technique showed that stapling the LAA leaves residual pouches that can be thrombogenic and that epicardial suture closure fails to close the LAA completely. 12 Murashita and colleagues 13 reported excellent long-term follow-up results with their longitudinal endocardial double-layer plication of the LAA orifice.…”