Key result
Baseline spontaneous echo contrast is not linked to device-related thrombus or thromboembolic events after LAAO.
Why the study?
Although spontaneous echo contrast is a known risk factor for atrial thrombus formation, whether it confers an increased risk of device-related thrombus or thromboembolic events following left atrial appendage occlusion was unclear.
Does the presence of spontaneous echo contrast increase the risk of device-related thrombus or thromboembolic events in patients undergoing left atrial appendage occlusion?
Observational (n=588)
Yes
Does the presence of spontaneous echo contrast increase the risk of device-related thrombus or thromboembolic events in patients undergoing left atrial appendage occlusion?
Answers are grounded in this paper and cite their sources.
The presence of spontaneous echo contrast prior to left atrial appendage occlusion does not appear to increase the risk of device-related thrombus or thromboembolic events at 1 year.
BACKGROUND: Interventional left atrial appendage occlusion (LAAO) provides an alternative to oral anticoagulation (OAC) for prophylaxis of thromboembolic events (TEs) in nonvalvular atrial fibrillation patients, predominantly in those with high bleeding risk and contraindications for long-term OAC. Although spontaneous echo contrast (SEC) is a well-known risk factor for atrial thrombus formation, little is known about whether this means an increased risk of device-related thrombus (DRT) or TEs following LAAO. METHODS: This substudy of the prospective, multicenter German LAARGE registry assessed two groups according to absence (SEC -) or presence of SEC (SEC +) in preprocedural cardiac imaging. Clinical and echocardiographic parameters were registered up to 1 year after LAAO. RESULTS: Five hundred eighty-eight patients (SEC - 85.5 vs. SEC + 14.5%) were included. More SEC + patients were implanted for OAC non-compliance (11.8 vs. 4.6%, p = 0.008) and a higher proportion received only antiplatelet therapy without OAC at hospital discharge (96.5 vs. 86.0%, p = 0.007). The SEC + patients had larger LA diameters (50 (47; 54) vs. 47 (43; 51) mm, p < 0.001), wider LAA ostia (21 (19; 23) vs. 20 (17; 22) mm at 45°, p = 0.011), and lower left ventricular ejection fraction (50 (45; 60) vs. 60 (50; 60) %, p < 0.001) on admission. Procedural success was very high in both groups (98.1%, p = 1.00). Periprocedural major adverse cardiac and cerebrovascular events and other major complications were rare in both groups (3.8 vs. 4.7%, p = 0.76). At follow-up, DRT was only detected in the SEC - group (3.8 vs. 0%, p = 1.00). The rates of TEs (SEC - 1.2 vs. SEC + 0%, p = 1.00) after hospital discharge and 1-year mortality (SEC - 12.0 vs. SEC + 11.8%, p = 0.96) were not significantly different between the two groups. CONCLUSIONS: Presence of SEC at baseline was not associated with an increased rate of DRT or TEs at 1-year follow-up after LAAO in LAARGE.
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Fastner et al. (2023) conducted an observational in Nonvalvular atrial fibrillation (n=588). Presence of spontaneous echo contrast (SEC+) vs. Absence of spontaneous echo contrast (SEC-) was evaluated on Device-related thrombus (DRT) at follow-up (p=1.00). Presence of spontaneous echo contrast at baseline was not associated with an increased rate of device-related thrombus (0% vs 3.8%, p=1.00) or thromboembolic events at 1-year follow-up after LAAO.
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