Recurrence of Device-Related Thrombus After Percutaneous Left Atrial Appendage Closure

Asmarats, Lluís; Cruz-González, Ignacio; Nombela‐Franco, Luis; Arzamendi, Dabit; Peral, Vicente; Nietlispach, Fabiàn; Latib, Azeem; Maffeo, Diego; González‐Ferreiro, Rocío; Rodríguez‐Gabella, Tania; Agudelo, Victor; Alamar, Marta; Ghenzi, Raffael A.; Mangieri, Antonio; Bernier, Martin; Rodés‐Cabau, Josep

doi:10.1161/circulationaha.119.040860

Cited by 41 publications

(31 citation statements)

References 5 publications

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“…23 Hence, in the absence of cost and benefit analysis, as well as guidelines to support simultaneous closure of LAA and ASD, our group has decided to close only patients with dilated atriums and established chronic atrial fibrillation as there was concern about increasing the risk for procedure-related complications. 22,24,25 In these patients, we opined that LAA closure can be performed even though patients do not have contraindications for oral anticoagulants. Our study offers the prospect of a novel indication for LAA closure in patients who are suitable candidates for transcatheter ASD closure with chronic atrial fibrillation.…”

Section: Discussionmentioning

confidence: 98%

“…Nyboe et al in their review of 1168 adult patients with ASDs found that over a median follow‐up period of 9.6 years (range: 1‐33 years), patients without prevalent atrial fibrillation had a 10‐year cumulative incidence of atrial fibrillation of 11% (95% CI 9‐14%) after closure compared with 2% (95% CI 1.8‐2.5%) 23 . Hence, in the absence of cost and benefit analysis, as well as guidelines to support simultaneous closure of LAA and ASD, our group has decided to close only patients with dilated atriums and established chronic atrial fibrillation as there was concern about increasing the risk for procedure‐related complications 22,24,25 . In these patients, we opined that LAA closure can be performed even though patients do not have contraindications for oral anticoagulants.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Left atrial appendage and atrial septal occlusion in elderly patients with atrial septal defect and atrial fibrillation

Leong

Kandavello

Husin

et al. 2020

Pacing Clinical Electrophis

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Background: Elderly patients with atrial septal defect (ASD) often present with chronic atrial fibrillation and large left to right shunt. This study reports the experience of left atrial appendage (LAA) and ASD closure in patients with significant ASD and chronic atrial fibrillation. Methods: We report six consecutive elderly patients with chronic atrial fibrillation and significant ASD who underwent LAA and fenestrated ASD closure from January 1, 2014 until December 31, 2019. All periprocedural and long-term (>1 year) outcomes were reported. Results: Six patients (male: 33.3%; mean age: 66.8 ± 3.3 years) were included. Mean CHADS 2 , CHA 2 DS 2-VAS c , and HAS-BLED scores were 2.33 ± 0.82, 3.83 ± 0.75, and 1.83 ± 0.75. Four patients underwent simultaneous procedure, while two patients underwent a staged procedure. Procedural success was achieved in all patients. Total occlusion was achieved during LAA occlusion without device embolization prior to ASD closure. Patients who underwent simultaneous procedure had a shorter total hospital stay and lower total hospital stay. During a follow-up period of 32.8 ± 19.4 months, both the devices were well seated. No device-related thrombosis or erosion reported. All patients remained in atrial fibrillation. No patients experienced any thromboembolic stroke or transient ischemic attack. Conclusions: LAA and ASD closure is feasible and can be safely performed in the same seating in elderly patients with a significant ASD.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Left atrial appendage and atrial septal occlusion in elderly patients with atrial septal defect and atrial fibrillation

Leong

Kandavello

Husin

et al. 2020

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…Patients with paroxysmal or newly onset atrial fibrillation may be treated via transcatheter ablation. Indiscriminately closing the LAA during ASD closure increases procedural cost and may even increase the patient's risk for procedure-related complications [17][18] . We, therefore opined that such a simultaneous approach should be patient-specific rather than universal.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Appendage and Atrial Septal Occlusion in Elderly Patients with Atrial Septal Defect and Atrial Fibrillation

Leong

Kandavello

Hussin

et al. 2020

Preprint

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Introduction: Elderly patients with ASD often present with chronic atrial fibrillation and large left to right shunt. This study reports the experience of left atrial appendage (LAA) and atrial septal defect (ASD) closure in patients with significant ASD and chronic atrial fibrillation. Methods / Results: We report six consecutive elderly patients with chronic atrial fibrillation and significant ASD who underwent LAA and fenestrated ASD closure from 1 January 2014 until 31 December 2019. All periprocedural and long term (>1 year) outcomes were reported. Six patients (Male: 33.3%; Mean age: 66.8±3.3 years) were included. Mean CHADS2, CHA2DS2-VASc¬ and HAS-BLED scores were 2.33±0.82, 3.83±0.75 and 1.83±0.75. Four patients underwent simultaneous procedure while 2 patients underwent a staged procedure. Procedural success was achieved in all patients. Total occlusion was achieved during LAA occlusion without device embolization prior to ASD closure. Patients who underwent simultaneous procedure had a shorter total hospital stay and lower total hospital stay. During a follow-up period of 32.8±19.4 months, both the devices were well seated. No device-related thrombosis or erosion reported. All patients remained in atrial fibrillation. No patients experienced any thromboembolic stroke or transient ischemic attack. Conclusion: LAA and ASD closure is feasible and can be safely performed in the same seating in elderly patients with a significant atrial septal defect.

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“…Although thrombus resolution was achieved in most patients with short-term OAC, approximately 50% of patients who stopped OAC had a recurrent DRT. 22 Furthermore, data on the predictors of DRT are heterogenous and are hindered by the small number of events. 23,24 At present, it remains unknown whether DRT is mostly related to patient factors (eg, ventricular function, duration of NVAF, etc), procedural factors (eg, peridevice leak or deep implantation), or to the type and duration of adjunctive antithrombotic therapy, or to a combination of these factors.…”

Section: Device-related Thrombusmentioning

confidence: 99%

Remaining Challenges With Transcatheter Left Atrial Appendage Closure

Alkhouli

Holmes

2020

Mayo Clinic Proceedings

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Recurrence of Device-Related Thrombus After Percutaneous Left Atrial Appendage Closure

Cited by 41 publications

References 5 publications

Left atrial appendage and atrial septal occlusion in elderly patients with atrial septal defect and atrial fibrillation

Left atrial appendage and atrial septal occlusion in elderly patients with atrial septal defect and atrial fibrillation

Left Atrial Appendage and Atrial Septal Occlusion in Elderly Patients with Atrial Septal Defect and Atrial Fibrillation

Remaining Challenges With Transcatheter Left Atrial Appendage Closure

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