Thromboembolic events and need for anticoagulation therapy following left atrial appendage occlusion in patients with electrical isolation of the appendage
| Autor: | Patrick Hranitzky, Javier Sanchez, Joseph G. Gallinghouse, Carola Gianni, Sanghamitra Mohanty, Varuna Gadiyaram, Linda Couts, Andrea Natale, Amin Al-Ahmad, Luigi Di Biase, Domenico G. Della Rocca, Chintan Trivedi, Douglas N. Gibson, David Burkhardt, Rodney Horton, Matthew J. Price |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Cardiac Catheterization Percutaneous Time Factors medicine.medical_treatment 030204 cardiovascular system & hematology Transesophageal echocardiogram Left atrial appendage occlusion Drug Administration Schedule 03 medical and health sciences 0302 clinical medicine Risk Factors Physiology (medical) Thromboembolism Antithrombotic Occlusion Atrial Fibrillation medicine Humans Atrial Appendage 030212 general & internal medicine Stroke Aged Retrospective Studies medicine.diagnostic_test business.industry Anticoagulants Atrial fibrillation Middle Aged medicine.disease United States Surgery Discontinuation Echocardiography Doppler Color Treatment Outcome Catheter Ablation Female Cardiology and Cardiovascular Medicine business Echocardiography Transesophageal |
| Zdroj: | Journal of cardiovascular electrophysiology. 30(4) |
| ISSN: | 1540-8167 |
| Popis: | Introduction Electrical isolation of the left atrial appendage (LAA) is an important adjunctive ablation strategy in patients with nonparoxysmal atrial fibrillation (AF). Patients who have impaired LAA contractility following isolation may require long-term oral anticoagulant (OAC) therapy irrespective of their CHADS2 -VASc score. Percutaneous LAA occlusion (LAAO) is a potential alternative to life-long OAC therapy. We aimed to assess the rate of OAC discontinuation and thromboembolic (TE) events following percutaneous LAAO in patients who underwent LAA electrical isolation (LAAI). Methods This is a retrospective two-center study of patients who underwent percutaneous LAAO following LAAI. Patients with at least 3-month follow-up were included in the study. The antithrombotic therapy and TE events at the time of the last follow-up were noted. Results The LAA was successfully occluded in 162 (with Watchman device in 140 [86.4%] and Lariat in 22 [13.6%]). A total of 32 patients had leaks detected on the 45-day transesophageal echocardiogram (TEE); 21 (15%) Watchman and 11 (50%) Lariat cases (P = 0.0001). Two (one Watchman and one Lariat) of the 32 leaks were more than 5 mm. After the 45-day TEE, 150 (92.6%) patients were off-OAC. No TE events were reported in the 150 patients who stopped the anticoagulants. Four (2.47%) patients experienced stroke following the LAAO (three Watchman and one Lariat) procedure while on-OAC, two of which were fatal. At the median follow-up of 18.5 months, 159 (98.15%) patients were off-anticoagulant. Conclusion Up to 98% of patients with LAAI could safely discontinue OAC after undergoing the appendage closure procedure. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text