Thromboembolic events and need for anticoagulation therapy following left atrial appendage occlusion in patients with electrical isolation of the appendage

Varuna K. Gadiyaram, Sanghamitra Mohanty, Carola Gianni, Chintan Trivedi, Amin Al-Ahmad, David J. Burkhardt, Joseph G. Gallinghouse, Patrick M. Hranitzky, Rodney P. Horton, Javier E. Sanchez, Domenico G. Della Rocca, Luigi Di Biase, Matthew J. Price, Linda Couts, Douglas Gibson, Andrea Natale

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalJournal of Cardiovascular Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2019

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Atrial Appendage
Anticoagulants
Therapeutics
Atrial Fibrillation
Stroke

Keywords

  • left atrial appendage
  • left atrial appendage occlusion
  • oral anticoagulation
  • thromboembolic events

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Thromboembolic events and need for anticoagulation therapy following left atrial appendage occlusion in patients with electrical isolation of the appendage. / Gadiyaram, Varuna K.; Mohanty, Sanghamitra; Gianni, Carola; Trivedi, Chintan; Al-Ahmad, Amin; Burkhardt, David J.; Gallinghouse, Joseph G.; Hranitzky, Patrick M.; Horton, Rodney P.; Sanchez, Javier E.; Della Rocca, Domenico G.; Di Biase, Luigi; Price, Matthew J.; Couts, Linda; Gibson, Douglas; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, 01.01.2019.

Research output: Contribution to journalArticle

Gadiyaram, VK, Mohanty, S, Gianni, C, Trivedi, C, Al-Ahmad, A, Burkhardt, DJ, Gallinghouse, JG, Hranitzky, PM, Horton, RP, Sanchez, JE, Della Rocca, DG, Di Biase, L, Price, MJ, Couts, L, Gibson, D & Natale, A 2019, 'Thromboembolic events and need for anticoagulation therapy following left atrial appendage occlusion in patients with electrical isolation of the appendage', Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.13838
Gadiyaram, Varuna K. ; Mohanty, Sanghamitra ; Gianni, Carola ; Trivedi, Chintan ; Al-Ahmad, Amin ; Burkhardt, David J. ; Gallinghouse, Joseph G. ; Hranitzky, Patrick M. ; Horton, Rodney P. ; Sanchez, Javier E. ; Della Rocca, Domenico G. ; Di Biase, Luigi ; Price, Matthew J. ; Couts, Linda ; Gibson, Douglas ; Natale, Andrea. / Thromboembolic events and need for anticoagulation therapy following left atrial appendage occlusion in patients with electrical isolation of the appendage. In: Journal of Cardiovascular Electrophysiology. 2019.
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abstract = "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.",
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T1 - Thromboembolic events and need for anticoagulation therapy following left atrial appendage occlusion in patients with electrical isolation of the appendage

AU - Gadiyaram, Varuna K.

AU - Mohanty, Sanghamitra

AU - Gianni, Carola

AU - Trivedi, Chintan

AU - Al-Ahmad, Amin

AU - Burkhardt, David J.

AU - Gallinghouse, Joseph G.

AU - Hranitzky, Patrick M.

AU - Horton, Rodney P.

AU - Sanchez, Javier E.

AU - Della Rocca, Domenico G.

AU - Di Biase, Luigi

AU - Price, Matthew J.

AU - Couts, Linda

AU - Gibson, Douglas

AU - Natale, Andrea

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - left atrial appendage

KW - left atrial appendage occlusion

KW - oral anticoagulation

KW - thromboembolic events

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