Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

Trevor Simard, Richard G. Jung, Kyle Lehenbauer, Kerstin Piayda, Radoslaw Pracoń, Gregory G. Jackson, Eduardo Flores-Umanzor, Laurent Faroux, Kasper Korsholm, Julian K.R. Chun, Shaojie Chen, Moniek Maarse, Kristi Montrella, Zakeih Chaker, Jocelyn N. Spoon, Luigi E. Pastormerlo, Felix Meincke, Abhishek C. Sawant, Carmen M. Moldovan, Mohammed QintarMehmet K. Aktas, Luca Branca, Andrea Radinovic, Pradhum Ram, Rayan S. El-Zein, Thomas Flautt, Wern Yew Ding, Bassel Sayegh, Tomás Benito-González, Oh Hyun Lee, Solomon O. Badejoko, Christina Paitazoglou, Nabeela Karim, Ahmed M. Zaghloul, Himanshu Agrawal, Rachel M. Kaplan, Oluseun Alli, Aamir Ahmed, Hussam S. Suradi, Bradley P. Knight, Venkata M. Alla, Sidakpal S. Panaich, Tom Wong, Martin W. Bergmann, Rashaad Chothia, Jung Sun Kim, Armando Pérez de Prado, Raveen Bazaz, Dhiraj Gupta, Miguel Valderrabano, Carlos E. Sanchez, Mikhael F. El Chami, Patrizio Mazzone, Marianna Adamo, Fred Ling, Dee Dee Wang, William O'Neill, Wojtek Wojakowski, Ashish Pershad, Sergio Berti, Daniel Spoon, Akram Kawsara, George Jabbour, Lucas V.A. Boersma, Boris Schmidt, Jens Erik Nielsen-Kudsk, Josep Rodés-Cabau, Xavier Freixa, Christopher R. Ellis, Laurent Fauchier, Marcin Demkow, Horst Sievert, Michael L. Main, Benjamin Hibbert, David R. Holmes, Mohamad Alkhouli*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Background: Device-related thrombus (DRT) has been considered an Achilles’ heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. Objectives: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. Methods: Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. Results: A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. Conclusions: DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.

Original languageEnglish (US)
Pages (from-to)297-313
Number of pages17
JournalJournal of the American College of Cardiology
Volume78
Issue number4
DOIs
StatePublished - Jul 27 2021

Keywords

  • ACP
  • Amplatzer cardiac plug
  • Amulet
  • DRT
  • LAAO
  • Watchman
  • Watchman FLX
  • device-related thrombus
  • left atrial appendage occlusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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