Management of thrombus formation after electrical isolation of the left atrial appendage in patients with atrial fibrillation
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Management of thrombus formation after electrical isolation of the left atrial appendage in patients with atrial fibrillation. / Fink, Thomas; Ouyang, Feifan; Heeger, Christian-Hendrik; Sciacca, Vanessa; Reissmann, Bruno; Keelani, Ahmad; Schütte, Christopher; Wohlmuth, Peter; Maurer, Tilman; Rottner, Laura; Eitel, Charlotte; Eitel, Ingo; Rillig, Andreas; Metzner, Andreas; Kuck, Karl-Heinz; Tilz, Roland Richard; Vogler, Julia.
In: EUROPACE, Vol. 22, No. 9, 01.09.2020, p. 1358-1366.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Management of thrombus formation after electrical isolation of the left atrial appendage in patients with atrial fibrillation
AU - Fink, Thomas
AU - Ouyang, Feifan
AU - Heeger, Christian-Hendrik
AU - Sciacca, Vanessa
AU - Reissmann, Bruno
AU - Keelani, Ahmad
AU - Schütte, Christopher
AU - Wohlmuth, Peter
AU - Maurer, Tilman
AU - Rottner, Laura
AU - Eitel, Charlotte
AU - Eitel, Ingo
AU - Rillig, Andreas
AU - Metzner, Andreas
AU - Kuck, Karl-Heinz
AU - Tilz, Roland Richard
AU - Vogler, Julia
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - AIMS: Left atrial appendage (LAA) electrical isolation (LAAEI) in addition to pulmonary vein isolation is an emerging catheter-based therapy to treat symptomatic atrial fibrillation. Previous studies found high incidences of LAA thrombus formation after LAAEI. This study sought to analyse therapeutic strategies aiming at the resolution of LAA thrombi and prevention of thromboembolism.METHODS AND RESULTS: Left atrial appendage electrical isolation was conducted via creation of left atrial linear lesions or cryoballoon ablation. Follow-up including transoesophageal echocardiography was conducted. In patients with LAA thrombus, oral anticoagulation (OAC) was adjusted until thrombus resolution was documented. Percutaneous LAA closure (LAAC) under use of a cerebral protection device was conducted in case of medically refractory LAA thrombi. Left atrial appendage thrombus was documented in 54 of 239 analysed patients who had undergone LAAEI. Thrombus resolution was documented in 39/51 patients (72.2%) with available follow-up after adjustment of OAC. Twenty-nine patients underwent LAAC and 10 patients were kept on OAC after LAAEI. No thromboembolic events or further LAA thrombi were documented after 553 ± 443 days of follow-up in these patients. Persistent LAA thrombi despite adaption of OAC was documented in 12/51 patients. One patient remained on OAC until the end of follow-up, while LAAC with a cerebral protection device was performed in 11 patients in the presence of LAA thrombus without complications.CONCLUSION: Left atrial appendage thrombus formation is common after LAAEI. Adjustment of OAC leads to LAA thrombus resolution in most patients. Left atrial appendage closure in the presence of LAA thrombi might be a feasible option in case of failed medical treatment.
AB - AIMS: Left atrial appendage (LAA) electrical isolation (LAAEI) in addition to pulmonary vein isolation is an emerging catheter-based therapy to treat symptomatic atrial fibrillation. Previous studies found high incidences of LAA thrombus formation after LAAEI. This study sought to analyse therapeutic strategies aiming at the resolution of LAA thrombi and prevention of thromboembolism.METHODS AND RESULTS: Left atrial appendage electrical isolation was conducted via creation of left atrial linear lesions or cryoballoon ablation. Follow-up including transoesophageal echocardiography was conducted. In patients with LAA thrombus, oral anticoagulation (OAC) was adjusted until thrombus resolution was documented. Percutaneous LAA closure (LAAC) under use of a cerebral protection device was conducted in case of medically refractory LAA thrombi. Left atrial appendage thrombus was documented in 54 of 239 analysed patients who had undergone LAAEI. Thrombus resolution was documented in 39/51 patients (72.2%) with available follow-up after adjustment of OAC. Twenty-nine patients underwent LAAC and 10 patients were kept on OAC after LAAEI. No thromboembolic events or further LAA thrombi were documented after 553 ± 443 days of follow-up in these patients. Persistent LAA thrombi despite adaption of OAC was documented in 12/51 patients. One patient remained on OAC until the end of follow-up, while LAAC with a cerebral protection device was performed in 11 patients in the presence of LAA thrombus without complications.CONCLUSION: Left atrial appendage thrombus formation is common after LAAEI. Adjustment of OAC leads to LAA thrombus resolution in most patients. Left atrial appendage closure in the presence of LAA thrombi might be a feasible option in case of failed medical treatment.
KW - Atrial Appendage/diagnostic imaging
KW - Atrial Fibrillation/diagnosis
KW - Catheter Ablation
KW - Humans
KW - Thromboembolism/etiology
KW - Thrombosis/diagnostic imaging
KW - Treatment Outcome
U2 - 10.1093/europace/euaa174
DO - 10.1093/europace/euaa174
M3 - SCORING: Journal article
C2 - 32743641
VL - 22
SP - 1358
EP - 1366
JO - EUROPACE
JF - EUROPACE
SN - 1099-5129
IS - 9
ER -
