Left atrial appendage closure in patients with or without previous embolic stroke/TIA. Data from the moncentric RESET registry

Abstract

Left atrial appendage (LAA) closure (LAAC) is indicated in patients with non valvular atrial fibrillation (AF) and contraindication to oral anticoagulation (OAC). Since December 2013, patients referred for LAAC have been included in a prospective registry and have given an informed consent for a five-year follow-up (FU). We compare charca and mid term follow up of those with (group S) and without (group NS) history of embolic stroke/TIA. Contra indication to OAC was established by a multidisciplinary team. Feasibility of LAAC was assessed by Cardiac Computed Tomography angiography. A 45 days TEE was planned. Thereafter patients received a phone call every 6 months. Available data were analyzed in case of adverse event. From 100 patients implanted, 29 had history of stroke. Demographics were not significantly different in both groups in term of age (77.1 ± 7.6 vs. 78 ± 7.2 yrs), sex (62% vs. 72% male), AF type (permanent in 55% vs. 49%), congestive heart failure (31% vs. 39%) and HAS BLED score (4.4 ± 1 in both). Obviously CHA2DS2VASc score was higher in S group (5.8 ± 1.4 vs. 4.2 ± 1.2%). LAA morphology was not different in both groups with a majority of Windsock type (59% vs. 55%), and a tendency of more Cactus type (17% vs. 5%) and less Chicken Wind type (24% vs 38%) in S group. Antithombotic treatment after implantation was not different in both groups, antiplatelet (66% vs. 65%), low dose anticoagulant for 45 days (10% vs. 6%), no ATT (24% vs. 27%). At 45 days 1 patient died from refractory bronchospasm in the N-S group. One year FU was obtained in 16 and 44 patients in group S and NS. No fatal or non-fatal embolic event occurred. A tendency of less death was noted in S-Group (6.3% vs. 29.5%). TEE was performed in 17 and 39 cases and a thrombus was detected in 2/17 (11.8%) patients in S group and 1/39 (2.6%) in N-S group. Patients with a history of previous stoke/TIA seem to have similar characteristics and prognosis than those without.