Percutaneous Left Appendage Closure Research Articles

Percutaneous Left Appendage Closure with the Watchman Device; The Challenges Lie Ahead: A Narrative Mini Review

Percutaneous Left Appendage Closure with the Watchman Device; The Challenges Lie Ahead: A Narrative Mini Review

0081: Percutaneous left appendage closure: real life outcomes and mid-term results during initial experience in a dedicated electrophysiology team

Percutaneous left atrial appendage closure (LAAC) is accepted as a valuable solution for patients (pts) with atrial fibrillation (AF) and high thromboembolic risk in case of contra-indication to oral anticoagulation (OAC). Little is known about mid-term results in the real life setting. We analyzed mid-term results in a dedicated EP team (2 experienced electrophysiologists [AF ablation >200 per yr], 1 echographist, 1 anesthesiologist). All indications were discussed before the procedure in a multidisciplinary approach. Procedures were done under general anesthesia in a dedicated EP room with in-hospital cardiac surgery facilities. All LAAC procedures were performed with Watchman devices (Boston Scientific). 50 pts were enrolled (male 76%, 77±6 years, paroxysmal AF 44%, permanent 54%). The CHADS2 VASC average score was 4.6±1,3; ≥4: 76%, HASBLED score was 3,7±1: ≥4: 64%. All indications were definitive contra-indications for OAC due to hemorrhagic events (neurological 75%, gastrointestinal 13%, ENT 3%, other 4%). The CT-scan ruled out any thrombus before the procedure for all pts with a perioperative TEE confirmation. Success rate of implantation was 100% (time of procedure 50±10 min, scopy time 8±3mn). There were no periprocedure complications. Postoperative therapy was: antiagregation 31%, double antiagregation 37%, anticoagulation 18%, none 3%. After 2 months, and TEE control, the initial treatment was switched to: antiagregation 50%, double antiagregation 10%, anticoagulation 10%, none 30%. Mid-term complications were: non severe pulmonary embolism N=1, recurrent non severe hemorrhagic stroke N=1, TIA due to carotid stenosis N=1. There were no other adverse events during 7,4±5 months follow-up. In a single center with large experience in EP, LAAC was performed with a very low rate of complications and excellent mid-term results regarding recurrences of thromboembolic and hemorrhagic events.

Survenue d’un accident ischémique cérébral chez un patient en fibrillation atriale sous anticoagulant oral : que faire de plus ?

Oral anticoagulants dramatically reduce the risk of embolic stroke in patients with atrial fibrillation (AF). However, each year, 1to 3% of patients will present an ischemic stroke despite being on oral anticoagulant. These events can result from efficacy fluctuations, non-cardioembolic stroke, or insufficient efficacy despite appropriate anticoagulation. There are several therapeutic options depending on presumed mechanism of ischemic stroke. However, none of these options has been specifically evaluated in appropriate studies. These options include: reinforcement of education or change in VKA drugs in case of documented therapeutic fluctuations, adjunction of aspirin, change to direct oral anticoagulants, or percutaneous left-appendage closure.

Pulmonary Artery Perforation by Plug Anchoring System After Percutaneous Closure of Left Appendage

Patients receiving oral anticoagulant therapy for atrial fibrillation who are at high risk of bleeding are increasingly referred for percutaneous left atrial appendage exclusion. Although effective, this procedure is not free from risk. We report a case of pericardial tamponade due to pulmonary artery tear caused by a trespassing anchoring hook of an AGA plug. Intraoperatively, no actual bleeding was found from the left appendage, a proof of its complete occlusion by the device. The patient underwent successful surgical repair and radio-frequency ablation of atrial fibrillation was performed by pulmonary veins encircling.