Outcome of left atrial appendage occlusion in high-risk patients

• Published in: Heart (British Cardiac Society) Vol. 104; no. 7; p. 594
• Main Authors: Masoud, Ahmed, Bartoletti, Stefano, Fairbairn, Timothy, Khurana, Ayush, Velavan, Periaswamy, Morrison, William Lindsay, Khalatbari, Afshin, Aggarwal, Suneil, Sharma, Nikhill, Kirchhof, Paulus, Gupta, Dhiraj
• Format: Journal Article
• Language: English
• Published: England 01-04-2018
• Subjects: Aged; Aged, 80 and over; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Atrial Appendage - diagnostic imaging; Atrial Appendage - surgery; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - mortality; Atrial Fibrillation - surgery; Echocardiography, Transesophageal - methods; Female; Hemorrhage - chemically induced; Hemorrhage - prevention & control; Humans; Male; Outcome and Process Assessment (Health Care); Postoperative Complications - classification; Postoperative Complications - diagnosis; Prosthesis Implantation - adverse effects; Prosthesis Implantation - methods; Risk Adjustment; Risk Assessment; Septal Occluder Device - adverse effects; Stroke - etiology; Stroke - prevention & control; United Kingdom; stroke; atrial fibrillation
• ISSN: 1468-201X
• DOI: 10.1136/heartjnl-2017-312383

Percutaneous left atrial appendage (LAA) occlusion can be an interventional alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation.
We delivered LAA occlusion therapy using a standardised approach to patient referral, multidisciplinary team assessment, implant criteria, imaging and follow-up. We analysed patient characteristics, efficacy and safety of the implant procedure, and 12-month outcomes.
Of 143 referrals from October 2014 to December 2016, 83 patients (age 76±8years, 32.5% female, mean CHAD
S
-VASc score 4 ±1) were offered LAA occlusion. Eighty (95.3%) had previous major bleeding (intracranial in 59%). LAA occluder implantation with an Amulet device was successful in 82 (98.8%), with periprocedural major adverse events occurring in 5 (6.0%) patients (2 device embolisations including 1 death, 2 major bleeds). Cardiac imaging in 75 (94%) patients 2months following implant showed device-related thrombus in 1 case (1.3%) and minor (<5mm) device leaks in 13 (17.1%). Over a median 12-month follow-up, 3 (3.8%) ischaemic strokes, 2 (2.5%) haemorrhagic strokes and 5 (6.3%) major extracranial bleeds occurred. All-cause mortality was 10%, with most deaths (7, 87.5%) due to non-cardiovascular causes.
LAA occlusion may be a reasonable option for stroke prevention inhigh-risk patients with atrial fibrillation ineligible for anticoagulation. However, procedural complication rates are not insignificant, and patients remain at risk of serious adverse events and death even after successful implant.