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Real-world survival data of device-related thrombus following left atrial appendage closure: 4-year experience from a single center

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Abstract

This study aimed to estimate the incidence and risk factors of device-related thrombus (DRT) following percutaneous left atrial appendage closure (LAAC) in real-world practices. Between February 2012 and December 2016, 319 consecutive patients with atrial fibrillation underwent percutaneous LAAC using WATCHMAN, WATCHMAN Flx, Amplatzer cardiac plug, and Amulet devices. All patients underwent transesophageal echocardiography (TEE) at a minimum of three time points; periprocedurally, at 45 days, and at 6 months. Other clinical parameters were also evaluated, and a comparison between patients with DRT and those not suffering from DRT was done. The percutaneous LAAC was successfully performed in 97.8% of the patients. DRT was detected in 14 (4.49%) patients; of the 14 patients, DRT was detected in 3 patients at acute phase, 8 patients at subacute phase, 2 patients at late phase and 1 patient at very late phase. Most of the DRT originated from the central screw of device. In 6 out of 14 patients, DRT was successfully resolved by oral anticoagulation. Higher HAS-BLED score (4.1 ± 1.2 vs. 3.5 ± 1.1, p = 0.042) was more frequent in patients with DRT. Multivariable analysis showed that residual peri-device leak may result in a predisposition to DRT (p = 0.023). The incidence of DRT after percutaneous LAAC was acceptable, as a part of the DRT was resolved with oral anticoagulation. Residual peri-device leak was associated with DRT. Optimal implantation without peri-device gap, individual antithrombotic regimens, and careful monitoring with TEE follow-up could be conducive to the prevention of DRT.

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Acknowledgements

The authors thank Cody R. Hou and Joseph Donnelly for their assistance in manuscript preparation.

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Author notes

  1. Yuan Bai and Xin Xue contributed equally.

Authors and Affiliations

  1. Department of Cardiology, Helmut-G.-Walther-Klinikum, Lichtenfels, Germany

    Yuan Bai, Xin Xue, Erich Duenninger, Manuela Muenzel, Lisheng Jiang, Adam Fazakas & Jiangtao Yu

  2. Department of Cardiology, Changhai Hospital, The Navy Military Medical University, Shanghai, China

    Yuan Bai

  3. Department of Cardiology, The Second Hospital, Jilin University, Changchun, China

    Xin Xue & Lisheng Jiang

  4. Department of Anesthesiology, Helmut-G.-Walther-Klinikum, Lichtenfels, Germany

    Thorsten Keil

  5. Clinic for General Internal Medicine and Cardiology, Katholisches Klinikum Koblenz Montabaur, Rudolf-Virchow-Str. 7, 56073, Koblenz, Germany

    Jiangtao Yu

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  1. Yuan Bai
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Correspondence to Jiangtao Yu.

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Bai, Y., Xue, X., Duenninger, E. et al. Real-world survival data of device-related thrombus following left atrial appendage closure: 4-year experience from a single center. Heart Vessels 34, 1360–1369 (2019). https://doi.org/10.1007/s00380-019-01364-7

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  • DOI: https://doi.org/10.1007/s00380-019-01364-7

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