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

Research output: Contribution to journalArticle

1 Citation (Scopus)

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

Fingerprint

Atrial Appendage
Atrial Fibrillation
Multicenter Studies
Ligation
Transesophageal Echocardiography
Equipment and Supplies
Aspirin
Thrombosis
Stroke

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Risk of thromboembolic events after percutaneous left atrial appendage ligation in patients with atrial fibrillation : Long-term results of a multicenter study. / Mohanty, Sanghamitra; Gianni, Carola; Trivedi, Chintan; Gadiyaram, Varuna; Della Rocca, Domenico Giovani; MacDonald, Bryan; Horton, Rodney; Al-Ahmad, Amin; Gibson, Douglas N.; Price, Matthew; Krumerman, Andrew K.; Palma, Eugen C.; Di Biase, Luigi; Lakkireddy, Dhanunjaya; Natale, Andrea.

In: Heart Rhythm, Vol. 17, No. 2, 02.2020, p. 175-181.

Research output: Contribution to journalArticle

Mohanty, S, Gianni, C, Trivedi, C, Gadiyaram, V, Della Rocca, DG, MacDonald, B, Horton, R, Al-Ahmad, A, Gibson, DN, Price, M, Krumerman, AK, Palma, EC, 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, vol. 17, no. 2, pp. 175-181. https://doi.org/10.1016/j.hrthm.2019.08.003
Mohanty, Sanghamitra ; Gianni, Carola ; Trivedi, Chintan ; Gadiyaram, Varuna ; Della Rocca, Domenico Giovani ; MacDonald, Bryan ; Horton, Rodney ; Al-Ahmad, Amin ; Gibson, Douglas N. ; Price, Matthew ; Krumerman, Andrew K. ; Palma, Eugen C. ; Di Biase, Luigi ; Lakkireddy, Dhanunjaya ; Natale, Andrea. / Risk of thromboembolic events after percutaneous left atrial appendage ligation in patients with atrial fibrillation : Long-term results of a multicenter study. In: Heart Rhythm. 2020 ; Vol. 17, No. 2. pp. 175-181.
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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.",
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T2 - Long-term results of a multicenter study

AU - Mohanty, Sanghamitra

AU - Gianni, Carola

AU - Trivedi, Chintan

AU - Gadiyaram, Varuna

AU - Della Rocca, Domenico Giovani

AU - MacDonald, Bryan

AU - Horton, Rodney

AU - Al-Ahmad, Amin

AU - Gibson, Douglas N.

AU - Price, Matthew

AU - Krumerman, Andrew K.

AU - Palma, Eugen C.

AU - Di Biase, Luigi

AU - Lakkireddy, Dhanunjaya

AU - Natale, Andrea

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N2 - 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.

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