Abstract
Introduction: There is no data reported on the occurrence of left atrial (LA) thrombus after LA appendage (LAA) closure with Lariat suture ligation device. We intend to identify the incidence and describe the clinical course of LA thrombi after Lariat procedure. Methods: We performed a multicenter observational study including all patients who underwent Lariat LAA exclusion. Patients underwent routine post-procedural TEE at approximately 1, 3 and 12 months follow-up. Additional TEEs were obtained as deemed necessary clinically. All patients in whom a LA thrombus was detected on TEE images were included in the study. Demographic characteristics, procedural variables, time of detection of LA thrombus were noted. Clinical course including duration of anticoagulation, serial TEEs and complications during follow up were recorded and analyzed. Results: Of the 1056 patients who underwent Lariat procedure, 8 patients (6 males; 2 females) were found to have a LA thrombus (0.007%). Median age, median CHADS2 score, median CHADS-Vasc score and median HASBLED score were 76 years, 3.5, 4.5 and 3 respectively. LA thrombus was detected after median interval of 36 days (IQR 32.5 -262.5). Thrombus was seen in close proximity of the LAA remnant in all patients. It was identified on the first follow-up TEE in all but one. In 1 patient 1.5 cm LA thrombus was seen at 427 days with prior TEEs being clear. Mean diameter of LA thrombus was 1.14 cm ± 0.3. Dabigatran was initiated in 2 patients and warfarin in the rest. After a median duration of 190 days (IQR 86-367.5), resolution of LA thrombus was observed in 7/8 patients. In 1 patient (on warfarin), there was a significant reduction in the size of the thrombus in the first and only TEE obtained 60 days after detection. In 1 patient on dabigatran, delayed resolution of thrombus was seen (occurring at 228days after detection). No embolic events were seen in any of the patients. Conclusion: Incidence of LA thrombus is rare after LARIAT LAA exclusion and can be safely managed with oral anticoagulation without any active intervention.
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