B-PO03-012 LEFT ATRIAL APPENDAGE CLOSURE DEVICE ASSOCIATED WITH LARGE THROMBUS

Abstract

The left atrial appendage (LAA) is an important source of embolic strokes in atrial fibrillation (AF). LAA occlusion (LAAO) devices have become accepted as an alternative to chronic anticoagulation (AC) therapy. However, the risk of thrombus post LAAO is not well defined. Reiterate the importance of appropriate patient selection for LAAO and relevance of transesophageal echo (TEE) prior to cardioversion (CV) in patients with LAAO. NA In 2018, a 73year-old male with a paroxysmal AF and intolerance to AC enrolled in Amulet™ LAA Occluder Trial. In 2016, his ejection fraction (EF) was 25% and improved to 40% by 2018. TEE 45 days post implant confirmed proper placement without thrombus. He was compliant with study protocol, discontinuing AC 45 days post implant and continued dual anti-platelet therapy secondary to extensive coronary disease. In 2020, he presented for TEE and CV secondary to symptomatic AF. TEE revealed severe left atrial enlargement with a large LAA thrombus attached to the surface of well-seated Amulet device, measuring 3.2x 3.3 x 2.5cm; EF 25-30%. He subsequently underwent surgical removal of Amulet device with thrombectomy and excision of LAA. Surgical intervention was chosen over AC therapy given recurrent falls and recent intracranial bleed. Major trials investigating LAAO devices excluded patients with an EF <30%. Thus, selecting participants for LAAO devices with significant LV dysfunction should be done with caution. Additionally, patients with LAAO devices undergoing CV should be screened for LAA thrombus to avoid potential catastrophic complications.