Percutaneous closure of atrial appendage with thrombus - a strategy shift? Report of a case series

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background. Percutaneous closure of left atrial appendage (LAAO) is a recent preventive modality in atrial fibrillation. (AF) However, presence of thrombus which is a strong stroke risk multiplier represented a standard contraindication to purely percutaneous approach. Aim. To test the safety and feasibility of LAAO in patients (pts) with appendage blood stasis and distal thrombus. Methods. Using a novel generation transvascular device allowing "shallow dive" implantation we tested the feasibility of LAAO in pts with appendage blood stasis and distal thrombus. Additionally, hybrid transvascular approach with arch protection device was also tested. Indications included development of heart failure in AF or recurrent cerebral events in pts with LAA thrombi. Results. We successfully performed 3 procedures in pts (2F, 1M, age 73-76) with distal LAA thrombus confirmed in 3D TEE / CT. After 3D echocardiographic sizing omitting appendage angiogram, occluder was implanted from right femoral venous access via septal puncture. In 2 patients right radial access was additionally used to introduce commercially available arch protection device. In all cases the occluder did not engage distal appendage zone and was appropriately deployed. However in patients with arch protection 1-2 mm debris was captured by protection device. No neurological sequelae were noted. Conclusion. Our initial experience documents safety and feasibility of percutaneous LAAO in presence of appendage blood stasis and distal thrombus based on 3DE sizing and novel genertaion device with optional percutaneous aortic arch protection. The long term efficacy of such unorthodox has yet to be determined in the setting of severely prothrombotic milieu, abnormal left ventricular function but with potential for risk reduction or even reopening options of cardioversion. Abstract Figure. Occlusion of LAA appendage with thrombus