Protection system

Result of closure of the left atrial appendix using a cerebral thrombosis protection system: no patient is left behind

This article was originally published here

Clin Electrophysiol stimulation. November 28, 2021. doi: 10.1111 / pace.14398. Online ahead of print.


Background: Left atrial thrombosis (LAA) increases the risk of stroke and its management should be evaluated. The aim of the present study is to assess the safety and the short- and long-term efficacy of a standardized approach to percutaneous left atrial appendage (LAAC) closure routinely using a brain protection device. (CPD) in patients with thrombosis or AAG sludge (LAAT).

METHODS: We prospectively recruited 14 consecutive patients with atrial fibrillation complicated by LAAT presenting in a high-volume tertiary center. In seven patients (50%) LAAT was found after stopping anticoagulants for severe bleeding and in the remaining half LAAT was found despite appropriate anticoagulant therapy. All patients were treated with a standardized LAAC interventional approach systematically using CPD and guided by transesophageal echocardiography.

RESULTS: The mean age was 68 ± 14 years and 9 patients (64%) were male. Average CHA2 DS2 -VASc and HAS-BLED scores were 3.3 ± 1.6 and 2.3 ± 1.1, respectively. Six patients (42.8%) presented organized thrombi while 8 ALA sludges (57.1%). In 13 patients (92.8%), the DPC was positioned through a right radial arterial access. The procedure was successful in all patients. In one patient, we witnessed the embolization of the thrombus during the deployment of the device in the absence of neurological consequences. During a mean follow-up of 426 ± 307 days, one patient died of non-cardiac cause while no embolic event or major bleeding was reported.

CONCLUSION: In an unselected cohort, LAAC with routine use of CPD was a feasible, safe, and effective treatment option for LAAT both acutely and after long-term follow-up. This article is protected by copyright. All rights reserved.

PMID: 34841552 | DOI: 10.1111 / pace.14398