Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes

Jules Mesnier, Trevor Simard, Richard G. Jung, Kyle R. Lehenbauer, Kerstin Piayda, Radoslaw Pracon, Gregory G. Jackson, Eduardo Flores-Umanzor, Laurent Faroux, Kasper Korsholm, Julian K.R. Chun, Shaojie Chen, Moniek Maarse, Kristi Montrella, Zakeih Chaker, Jocelyn N. Spoon, Luigi E. Pastormerlo, Felix Meincke, Abhishek C. Sawant, Carmen M. MoldovanMohammed Qintar, Mehmet K. Aktas, Luca Branca, Andrea Radinovic, Pradhum Ram, Rayan S. El-Zein, Thomas Flautt, Wern Yew Ding, Bassel Sayegh, Tomás Benito-González, Oh Hyun Lee, Solomon O. Badejoko, Christina Paitazoglou, Nabeela Karim, Ahmed M. Zaghloul, Himanshu Agarwal, Rachel M. Kaplan, Oluseun Alli, Aamir Ahmed, Hussam S. Suradi, Bradley P. Knight, Venkata M. Alla, Sidakpal S. Panaich, Tom Wong, Martin W. Bergmann, Rashaad Chothia, Jung Sun Kim, Armando Pérez de Prado, Raveen Bazaz, Dhiraj Gupta, Miguel Valderrábano, Carlos E. Sanchez, Mikhael F. El Chami, Patrizio Mazzone, Marianna Adamo, Fred Ling, Dee Dee Wang, William O'Neill, Wojtek Wojakowski, Ashish Pershad, Sergio Berti, Daniel B. Spoon, Akram Kawsara, George Jabbour, Lucas V.A. Boersma, Boris Schmidt, Jens Erik Nielsen-Kudsk, Xavier Freixa, Christopher R. Ellis, Laurent Fauchier, Marcin Demkow, Horst Sievert, Michael L. Main, Benjamin Hibbert, David R. Holmes, Mohamad Alkhouli, Josep Rodés-Cabau

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2722-2732
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume16
Issue number22
DOIs
StatePublished - Nov 27 2023

Keywords

  • atrial fibrillation
  • device-related thrombus
  • left atrial appendage occlusion
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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