Author + information
- Received May 23, 2019
- Revision received September 5, 2019
- Accepted November 21, 2019
- Published online April 20, 2020.
- Sharan Prakash Sharma, MDa,
- Jie Cheng, MDb,
- Mohit K. Turagam, MDc,
- Rakesh Gopinathannair, MDa,
- Rodney Horton, MDb,
- Yat-yin Lam, MDd,
- Giuseppe Tarantini, MDe,
- Gianpiero D'Amico, MDe,
- Xavier Freixa Rofastes, MDf,
- Mathias Lange, MDg,
- Andrea Natale, MDb and
- Dhanunjaya R. Lakkireddy, MDa,∗ ()
- aKansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas
- bTexas Cardiac Arrhythmia Institute, Austin, Texas
- cIcahn School of Medicine at Mount Sinai, New York, New York
- dDepartment of Cardiology, Prince of Wales Hospital, Hong Kong
- eDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
- fHospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- gDepartment of Cardiology, Heart Center Osnabrück, Osnabrück, Germany
- ↵∗Address for correspondence:
Dr. Dhanunjaya R. Lakkireddy, University of Missouri-Columbia, The Kansas City Heart Rhythm Institute (KCHRI) @ HCA MidWest, 12200, West 106th Street, Overland Park Regional Medical Center, Overland Park, Kansas 66215.
Objectives This study aimed to investigate the feasibility and safety of left atrial appendage occlusion (LAAO) procedures in patients with persistent left atrial appendage (LAA) thrombus.
Background The left atrial appendage (LAA) is the most common site of thrombus formation in patients with nonvalvular atrial fibrillation (AF). Oral anticoagulation (OAC) is used to prevent and treat AF-related thrombus. However, a significant proportion of patients may not be eligible for long-term OAC therapy. In many cases, OAC may fail to resolve the thrombus. Left atrial appendage occlusion (LAAO) may be a potential option in such cases. Major LAAO studies have excluded patients with LAA thrombus, and it is not known whether LAAO procedures in the presence of LAA thrombus is feasible and safe.
Methods This was a systematic review of patient-level data of all published cases of LAAO in the presence of LAA thrombus.
Results There was a total of 58 patients included in the study. Most of the patients had a distally located thrombus in the LAA. All cases underwent successful implantation of LAAO devices with some procedural modifications. Amulet was the most commonly used device (50%). A cerebral protection device was used in 17 (29%) patients, and procedural transesophageal echocardiography was used in most of the cases. One stroke (1.7%) and 2 (3.4%) device-related thromboses were noted during the mean follow-up of 3.4 ± 7 months.
Conclusions Percutaneous LAAO procedures appear to be feasible in patients with a distally located persistent LAA thrombus when performed by experienced operators with some technical modifications. Further studies are required to determine the long-term safety and efficacy of this approach.
- Amplatzer cardiac plug
- left atrial appendage occlusion
- left atrial appendage thrombosis
- oral anticoagulation
Dr. Rofastes has been a proctor for Abbott Medical and Lifetech. Dr. Natale has been a consultant and speaker for Biosense Webster, Medtronic, Biotronik, Abbott, Boston Scientific, Baylis, and Bristol-Myers Squibb. Dr. Lakkireddy has been a consultant for Abbott and Atriclip. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 23, 2019.
- Revision received September 5, 2019.
- Accepted November 21, 2019.
- 2020 American College of Cardiology Foundation
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