Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes.
Document Type
Article
Publication Title
JACC Cardiovasc Interv
Abstract
BACKGROUND: Scarce data exist on the evolution of device-related thrombus (DRT) after left atrial appendage closure (LAAC).
OBJECTIVES: This study sought to assess the incidence, predictors, and clinical impact of persistent and recurrent DRT in LAAC recipients.
METHODS: Data were obtained from an international multicenter registry including 237 patients diagnosed with DRT after LAAC. Of these, 214 patients with a subsequent imaging examination after the initial diagnosis of DRT were included. Unfavorable evolution of DRT was defined as either persisting or recurrent DRT.
RESULTS: DRT resolved in 153 (71.5%) cases and persisted in 61 (28.5%) cases. Larger DRT size (OR per 1-mm increase: 1.08; 95% CI: 1.02-1.15; P = 0.009) and female (OR: 2.44; 95% CI: 1.12-5.26; P = 0.02) were independently associated with persistent DRT. After DRT resolution, 82 (53.6%) of 153 patients had repeated device imaging, with 14 (17.1%) cases diagnosed with recurrent DRT. Overall, 75 (35.0%) patients had unfavorable evolution of DRT, and the sole predictor was average thrombus size at initial diagnosis (OR per 1-mm increase: 1.09; 95% CI: 1.03-1.16; P = 0.003), with an optimal cutoff size of 7 mm (OR: 2.51; 95% CI: 1.39-4.52; P = 0.002). Unfavorable evolution of DRT was associated with a higher rate of thromboembolic events compared with resolved DRT (26.7% vs 15.1%; HR: 2.13; 95% CI: 1.15-3.94; P = 0.02).
CONCLUSIONS: About one-third of DRT events had an unfavorable evolution (either persisting or recurring), with a larger initial thrombus size (particularly >7 mm) portending an increased risk. Unfavorable evolution of DRT was associated with a 2-fold higher risk of thromboembolic events compared with resolved DRT.
First Page
2722
Last Page
2732
DOI
10.1016/j.jcin.2023.09.017
Publication Date
11-27-2023
Recommended Citation
Mesnier, Jules; Simard, Trevor; Jung, Richard G; Lehenbauer, Kyle R; Piayda, Kerstin; Pracon, Radoslaw; Jackson, Gregory G; Flores-Umanzor, Eduardo; Faroux, Laurent; Korsholm, Kasper; Chun, Julian K R; Chen, Shaojie; Maarse, Moniek; Montrella, Kristi; Chaker, Zakeih; Spoon, Jocelyn N; Pastormerlo, Luigi E; Meincke, Felix; Sawant, Abhishek C; Moldovan, Carmen M; Qintar, Mohammed; Aktas, Mehmet K; Branca, Luca; Radinovic, Andrea; Ram, Pradhum; El-Zein, Rayan S; Flautt, Thomas; Ding, Wern Yew; Sayegh, Bassel; Benito-González, Tomás; Lee, Oh-Hyun; Badejoko, Solomon O; Paitazoglou, Christina; Karim, Nabeela; Zaghloul, Ahmed M; Agarwal, Himanshu; Kaplan, Rachel M; Alli, Oluseun; Ahmed, Aamir; Suradi, Hussam S; Knight, Bradley P; Alla, Venkata M; Panaich, Sidakpal S; Wong, Tom; Bergmann, Martin W; Chothia, Rashaad; Kim, Jung-Sun; Pérez de Prado, Armando; Bazaz, Raveen; Gupta, Dhiraj; Valderrábano, Miguel; Sanchez, Carlos E; El Chami, Mikhael F; Mazzone, Patrizio; Adamo, Marianna; Ling, Fred; Wang, Dee Dee; O'Neill, William; Wojakowski, Wojtek; Pershad, Ashish; Berti, Sergio; Spoon, Daniel B; Kawsara, Akram; Jabbour, George; Boersma, Lucas V A; Schmidt, Boris; Nielsen-Kudsk, Jens Erik; Freixa, Xavier; Ellis, Christopher R; Fauchier, Laurent; Demkow, Marcin; Sievert, Horst; Main, Michael L; Hibbert, Benjamin; Holmes, David R; Alkhouli, Mohamad; and Rodés-Cabau, Josep, "Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes." (2023). Heart and Vascular Articles. 24.
https://scholarlyworks.ohiohealth.com/heart-vascular-articles/24