Risk of thromboembolic events after percutaneous left atrial appendage ligation in patients with atrial fibrillation: Long-term results of a multicenter study

Sanghamitra Mohanty, Carola Gianni, Chintan Trivedi, Varuna Gadiyaram, Domenico Giovani Della Rocca, Bryan MacDonald, Rodney Horton, Amin Al-Ahmad, Douglas N. Gibson, Matthew Price, Andrew K. Krumerman, Eugen C. Palma, Luigi Di Biase, Dhanunjaya Lakkireddy, Andrea Natale

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2 Scopus citations

Abstract

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 < .001). 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.

Original languageEnglish (US)
Pages (from-to)175-181
Number of pages7
JournalHeart Rhythm
Volume17
Issue number2
DOIs
StatePublished - Feb 2020

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Keywords

  • Lariat
  • Leak
  • Left atrial appendage
  • Oral anticoagulation
  • TE risk

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Mohanty, S., Gianni, C., Trivedi, C., Gadiyaram, V., Della Rocca, D. G., MacDonald, B., Horton, R., Al-Ahmad, A., Gibson, D. N., Price, M., Krumerman, A. K., Palma, E. C., Di Biase, L., Lakkireddy, D., & Natale, A. (2020). Risk of thromboembolic events after percutaneous left atrial appendage ligation in patients with atrial fibrillation: Long-term results of a multicenter study. Heart Rhythm, 17(2), 175-181. https://doi.org/10.1016/j.hrthm.2019.08.003