AIMS: To investigate the feasibility, safety and efficacy of percutaneous closure for prevention of thromboembolic events in patients with atrial fibrillation (AF) and left atrial appendage (LAA) thrombus. METHODS AND RESULTS: The study included consecutive patients with AF and LAA thrombus who underwent transcatheter occlusion in 8 high-volume centers. Clinical and transesophageal echocardiography (TEE) follow-up was carried as per each center's protocol. Twenty-eight patients were included. The location of the LAA thrombus was distal in 100% of cases. Technical and procedural success was achieved in all patients. A cerebral protection device was used in 6 cases. There were no peri-procedural adverse events. Follow-up was complete in all patients (total 32 patient-years). No death or thromboembolic events were reported. There was one major bleeding during follow-up. Among the 23 patients undergoing TEE, device thrombosis was present in one patient. No significant peri-device leaks were observed. CONCLUSIONS: In this multicenter study, percutaneous closure in selected patients with distal LAA thrombus appears to be feasible and safe, associated with high procedural success and a favorable outcome for the prevention of AF-related thromboembolism. Special implant techniques avoiding mechanical mobilization of the thrombotic mass and the liberal use of cerebral embolic protection devices are recommended.

Percutaneous left atrial appendage occlusion in patients with atrial fibrillation and left appendage thrombus: feasibility, safety and clinical efficacy

Tarantini, Giuseppe;D'amico, Gianpiero;RONCO, FEDERICO;
2017

Abstract

AIMS: To investigate the feasibility, safety and efficacy of percutaneous closure for prevention of thromboembolic events in patients with atrial fibrillation (AF) and left atrial appendage (LAA) thrombus. METHODS AND RESULTS: The study included consecutive patients with AF and LAA thrombus who underwent transcatheter occlusion in 8 high-volume centers. Clinical and transesophageal echocardiography (TEE) follow-up was carried as per each center's protocol. Twenty-eight patients were included. The location of the LAA thrombus was distal in 100% of cases. Technical and procedural success was achieved in all patients. A cerebral protection device was used in 6 cases. There were no peri-procedural adverse events. Follow-up was complete in all patients (total 32 patient-years). No death or thromboembolic events were reported. There was one major bleeding during follow-up. Among the 23 patients undergoing TEE, device thrombosis was present in one patient. No significant peri-device leaks were observed. CONCLUSIONS: In this multicenter study, percutaneous closure in selected patients with distal LAA thrombus appears to be feasible and safe, associated with high procedural success and a favorable outcome for the prevention of AF-related thromboembolism. Special implant techniques avoiding mechanical mobilization of the thrombotic mass and the liberal use of cerebral embolic protection devices are recommended.
2017
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/3243392
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