Is spontaneous echo contrast associated with device-related thrombus or embolic events after left atrial appendage occlusion? - Insights from the multicenter German LAARGE registry

• Published in: Journal of interventional cardiac electrophysiology Vol. 67; no. 1; pp. 119 - 128
• Main Authors: Fastner, Christian, Müller, Claus, Brachmann, Johannes, Lewalter, Thorsten, Akin, Ibrahim, Sievert, Horst, Käunicke, Matthias, Zeymer, Uwe, Hochadel, Matthias, Schneider, Steffen, Senges, Jochen, Erkapic, Damir, Weiß, Christian
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2024; Springer Nature B.V
• Subjects: Anticoagulants; Antiplatelet therapy; Appendages; Atrial Appendage - diagnostic imaging; Atrial Appendage - surgery; Atrial Fibrillation - complications; Atrial Fibrillation - surgery; Blood clots; Cardiology; Complications; Heart; Hospitals; Humans; Medicine; Medicine & Public Health; Occlusion; Patients; Prophylaxis; Prospective Studies; Registries; Risk factors; Stroke - prevention & control; Stroke Volume; Thromboembolism; Thromboembolism - etiology; Thromboembolism - prevention & control; Thrombosis; Thrombosis - diagnostic imaging; Thrombosis - etiology; Thrombosis - prevention & control; Treatment Outcome; Ventricle; Ventricular Function, Left; Bleeding risk; Ischemic stroke; Interventional approach; Thromboembolism; Atrial fibrillation; Left atrial appendage closure
• ISSN: 1572-8595; 1383-875X; 1572-8595
• DOI: 10.1007/s10840-023-01567-z

Background Interventional left atrial appendage occlusion (LAAO) provides an alternative to oral anticoagulation (OAC) for prophylaxis of thromboembolic events (TEs) in nonvalvular atrial fibrillation patients, predominantly in those with high bleeding risk and contraindications for long-term OAC. Although spontaneous echo contrast (SEC) is a well-known risk factor for atrial thrombus formation, little is known about whether this means an increased risk of device-related thrombus (DRT) or TEs following LAAO. Methods This substudy of the prospective, multicenter German LAARGE registry assessed two groups according to absence (SEC −) or presence of SEC (SEC +) in preprocedural cardiac imaging. Clinical and echocardiographic parameters were registered up to 1 year after LAAO. Results Five hundred eighty-eight patients (SEC − 85.5 vs. SEC + 14.5%) were included. More SEC + patients were implanted for OAC non-compliance (11.8 vs. 4.6%, p  = 0.008) and a higher proportion received only antiplatelet therapy without OAC at hospital discharge (96.5 vs. 86.0%, p  = 0.007). The SEC + patients had larger LA diameters (50 (47; 54) vs. 47 (43; 51) mm, p  < 0.001), wider LAA ostia (21 (19; 23) vs. 20 (17; 22) mm at 45°,  p = 0.011), and lower left ventricular ejection fraction (50 (45; 60) vs. 60 (50; 60) %, p  < 0.001) on admission. Procedural success was very high in both groups (98.1%, p  = 1.00). Periprocedural major adverse cardiac and cerebrovascular events and other major complications were rare in both groups (3.8 vs. 4.7%, p  = 0.76). At follow-up, DRT was only detected in the SEC − group (3.8 vs. 0%, p  = 1.00). The rates of TEs (SEC − 1.2 vs. SEC + 0%, p  = 1.00) after hospital discharge and 1-year mortality (SEC − 12.0 vs. SEC + 11.8%, p  = 0.96) were not significantly different between the two groups. Conclusions Presence of SEC at baseline was not associated with an increased rate of DRT or TEs at 1-year follow-up after LAAO in LAARGE.