Risk of thromboembolic events after percutaneous left atrial appendage ligation in patients with atrial fibrillation: Long-term results of a multicenter study
| Autor: | Carola Gianni, Dhanunjaya Lakkireddy, Andrew Krumerman, Amin Al-Ahmad, Rodney Horton, Andrea Natale, Varuna Gadiyaram, Sanghamitra Mohanty, Bryan MacDonald, Eugen C. Palma, Domenico G. Della Rocca, Matthew J. Price, Chintan Trivedi, Douglas N. Gibson, Luigi Di Biase |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Leak medicine.medical_specialty Cardiac Catheterization Percutaneous Time Factors 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences 0302 clinical medicine Risk Factors Physiology (medical) Thromboembolism Occlusion Atrial Fibrillation medicine Humans Atrial Appendage 030212 general & internal medicine Thrombus Cardiac Surgical Procedures Ligation Aged Retrospective Studies Aspirin business.industry Incidence Atrial fibrillation medicine.disease United States Surgery Discontinuation Echocardiography Doppler Color Treatment Outcome Female Cardiology and Cardiovascular Medicine business Echocardiography Transesophageal medicine.drug Follow-Up Studies |
| Zdroj: | Heart rhythm. 17(2) |
| ISSN: | 1556-3871 |
| Popis: | Background Percutaneous left atrial appendage (LAA) occlusion with Lariat has emerged as a viable alternative to oral anticoagulation (OAC) to prevent thromboembolic (TE) events in patients with atrial fibrillation. Objective We evaluated the long-term TE risk in post-Lariat patients. Methods Consecutive patients undergoing LAA ligation with the Lariat device at multiple centers with at least 1-year follow-up were included in the analysis. Transesophageal echocardiography (TEE) was performed at 4 weeks, 6 months, and 12 months to assess the completeness of LAA occlusion. OAC was discontinued if 4-week TEE revealed no device-related thrombus and complete closure of the appendage. Patients remained on 81 mg of aspirin per day after discontinuation of the blood thinner. Results A total of 306 patients were included in the study (mean age 68.8 ± 11.0 years; mean CHA2DS2-VASc score 3.6 ± 1.7). Four-week TEE revealed leaks in 81 patients (26.5%); all leaks were less than 5 mm in diameter. At 6-month TEE, spontaneous closure of the leak was demonstrated in 21 patients (25.9%), 26 patients (32%) underwent a successful leak closure procedure, and the remaining 34 (42%) patients were placed on OAC. At the median follow-up period of 15.9 ± 9.2 months, 9 TE events (2.9%) were reported: 7 with persistent leak and 2 without any detectable leaks on 2-dimensional TEE (P Conclusion Complete occlusion of the LAA with the Lariat device was associated with the low rate of TE events at long-term follow-up. However, residual leaks were common after Lariat closure and the stroke rate was significantly higher in patients with incomplete occlusion, even with small leaks. |
| Databáze: | OpenAIRE |
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