Single Centre Experience of Left Atrial Appendage Closure in Patients with Non-Valvular Atrial Fibrillation and Contraindication to Anticoagulation

Abstract

Background: Patients who have a high CHA2DS2-VASc score associated with non-valvular atrial fibrillation (AF) would ordinarily benefit from anticoagulation. However, contraindications to anticoagulation may lead to a management dilemma. Left atrial appendage (LAA) closure was shown to be non-inferior to warfarin in preventing stroke in the PROTECT AF trial. We present a single centre study of 52 patients from 2011 to 2016 with contraindications to anticoagulation who had LAA closure. Results: The mean age was 70.62 years (range 49-89years) and mean CHA2DS2-VASc score was 3.62 (SD 1.22). 100% of patients received a closure device; 44 the WATCHMAN device, 7 the wavecrest and 1 was an Amplatzer duct occluder. The mean size was 25.4 mm (range 21 -33 mm). Occlusion rate was 100% and confirmed by intra operative transoesohageal echocardiogram. Mean procedure length was 66 minutes (range 31-147 minutes). Mean fluroscopy time was 18.22 minutes (SD 13.80 minutes). There was one intra operative death from tamponade with unsuccessful resuscitation following device deployment. One patient had intraoperative ventricular tachycardia (VT) with successful defibrillation. 43 of the 52 patients have had at least 1 year of follow-up. The expected stroke rate based on the mean CHA2DS2-VASc was 4%. One patient had a transient ischaemic attack (TIA) and no clinically significant bleeds (BARC ≥ 3) occurred. One patient developed a device thrombus, which resolved after subsequent anticoagulation. Conclusions: Given the results of this small cohort study, LAA closure offers a reasonable and efficient alternative to anticoagulation. However, it is not without risks as reflected in the one death that occurred.