Left Atrial Thrombus Formation After Successful Left Atrial Appendage Ligation

Lakkireddy, Dhanunjaya; Vallakati, Ajay; Kanmanthareddy, Arun; Feldman, Ted; Gibson, Douglas; Price, Matthew J.; Rubenson, David; Cheng, Jie; Valderrábano, Miguel; Fernando, Rajeev; Laing, Susan T.; Chung, Eugene H.; Bommana, Sudharani; Atkins, Donita; Pillarisetti, Jayasree; Knight, Bradley P.; Evonich, Rudolph; Rasekh, Abdi; Gray, James; Sridhar, Arun Raghav Mahankali; Earnest, Mathew; Ferrell, Ryan; Nath, Jayant; Reddy, Yeruva Madhu

doi:10.1016/j.jacc.2015.01.052

Cited by 14 publications

(8 citation statements)

References 3 publications

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“…The 1.4% rate of thrombus formation is consistent withother studies reporting thrombus formation between 1.2% and 2.0% with LAA ligation using the Lariat device(25,37,38). In a nationwide survey, the majority of thrombus formation (79%) following LAA ligation with the Lariat device occurs within the first 3 months(38). Although the incidence of thrombus formation and the incidence of stroke is low after 1 year (25,38), a 12-month follow-up TEE in addition to a TEE between 45 and 90 days should be considered.…”

supporting

confidence: 89%

“…The initial inflammatory response inherently causes endothelial cell injury at the site of closure, providing the environment for platelet aggregation and thrombus formation. The 1.4% rate of thrombus formation is consistent withother studies reporting thrombus formation between 1.2% and 2.0% with LAA ligation using the Lariat device(25,37,38). In a nationwide survey, the majority of thrombus formation (79%) following LAA ligation with the Lariat device occurs within the first 3 months(38).…”

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confidence: 86%

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Left Atrial Appendage Ligation in Nonvalvular Atrial Fibrillation Patients at High Risk for Embolic Events With Ineligibility for Oral Anticoagulation

Sievert

Rasekh

Bartus

et al. 2015

JACC: Clinical Electrophysiology

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confidence: 89%

supporting

confidence: 86%

Left Atrial Appendage Ligation in Nonvalvular Atrial Fibrillation Patients at High Risk for Embolic Events With Ineligibility for Oral Anticoagulation

Sievert

Rasekh

Bartus

et al. 2015

JACC: Clinical Electrophysiology

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“…This practice was used as a precautionary measure because thrombus formation has been repeatedly reported to occur after Lariat closure. [16][17][18][19][20][21] The choice of anticoagulating agent was left to the discretion of the performing physician. …”

mentioning

confidence: 99%

Left Atrial Appendage Remodeling After Lariat Left Atrial Appendage Ligation

Kreidieh

Rojas

Schürmann

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-Left atrial appendage (LAA) ligation with the Lariat device is being used for stroke prevention in atrial fibrillation. Residual leaks into the LAA are commonly reported after the procedure. Little is known about the anatomic LAA remodeling after Lariat ligation. Methods and Results-In an exploratory study, we evaluated LAA 3-dimensional geometry via computed tomographic scan in 31 consecutive patients before Lariat closure and after a minimum of 30 days post procedure. Thirteen patients were classified as unfavorable cases based on anatomic criteria. Our population had an average age of 70±12 years, a mean CHADS2 (congestive heart failure, hypertension, age>75, diabetes mellitus, history of stroke) score of 3.2±1.2, a mean CHADS2VASC (CHADS2 in addition to female sex, ages 65-75, as well as double impact of age >75, vascular disease) of 4.2±1.5, and a mean HASBLED (hypertension, abnormal renal/liver function, stroke, bleeding predisposition/history, labile international normalized ratio, elderly, drugs/alcohol) bleeding score of 4.0±1.1. Successful suture deployment was achieved in all cases, but 3 patients had intraprocedural residual flow into the LAA (leak). On follow-up, 10 patients (32%) had recanalized residual LAA cavities, which were morphologically similar to the original LAA, albeit significantly smaller in volume (22.5±13.3% of the original volume). Recanalization was not associated with age, sex, comorbid conditions, stroke or bleeding risk scores, follow-up interval, baseline LAA volume, or morphology. protocol. Initial data (n=8) were collected retrospectively from patient charts. The subsequent 23 patients were consecutive patients studied prospectively. This data included medical history, procedural reports, and major events, including thromboembolic and hemorrhagic incidences. CHADS2 (congestive heart failure, hypertension, age>75, diabetes mellitus, history of stroke), CHADS2VASC (CHADS2 in addition to female sex, ages 65-75, as well as double impact of age >75, vascular disease), and HASBLED (hypertension, abnormal renal/liver function, stroke, bleeding predisposition/history, labile international normalized ratio, elderly, drugs/alcohol) scores were then calculated (Table 1). Patient SelectionA total of 31 AF patients undergoing transcatheter LAA closure with the Lariat device were included in the study. Patients were assigned to the procedure based on clinical indication and anatomic eligibility. Clinical indication included individuals with a history or predisposition to thromboembolism concomitantly with a high risk of bleeding for whom long-term anticoagulation was contraindicated. Every patient's CHADS2, CHADS2VASC, and HASBLED scores, as well as anticoagulation history, were thoroughly examined, and those with elevated scores were considered. A clinical decision to recommend LAA isolation over oral anticoagulation (OAC) was then made by the treating physician. In 25 patients, a history of major bleed was the main reason for avoiding long-term maintenance on OAC. One patient ...

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“…During this span, refinements for the LARIAT included improved patient selection with increased operator experience, the adoption of a micropuncture needle and telescoping technique for “dry” pericardial access, and periprocedural colchicine for pericarditis prophylaxis . Despite the overall favorable trend, LARIAT‐related MAUDE data suffer from underreporting, as evidenced by the absence of reports for postprocedural LAA leaks and intracardiac thrombi, which are well‐documented in the literature …”

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confidence: 99%

Safety profiles of percutaneous left atrial appendage closure devices: An analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database from 2009 to 2016

Jazayeri

Vuddanda

Turagam

et al. 2017

Cardiovasc electrophysiol

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Background: Percutaneous left atrial appendage closure (LAAC) is a viable option for AF patients who are unable to tolerate long-term oral anticoagulation (OAC). Objective:We sought to assess the safety of two commonly used percutaneous devices for LAA closure in the United States by analysis of surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database. Methods

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Left Atrial Thrombus Formation After Successful Left Atrial Appendage Ligation

Cited by 14 publications

References 3 publications

Left Atrial Appendage Ligation in Nonvalvular Atrial Fibrillation Patients at High Risk for Embolic Events With Ineligibility for Oral Anticoagulation

Left Atrial Appendage Ligation in Nonvalvular Atrial Fibrillation Patients at High Risk for Embolic Events With Ineligibility for Oral Anticoagulation

Left Atrial Appendage Remodeling After Lariat Left Atrial Appendage Ligation

Safety profiles of percutaneous left atrial appendage closure devices: An analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database from 2009 to 2016

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