Key result
LAmbre closure in large LAA is linked to ~7% delayed pericardial effusion versus normal LAA.
Why the study?
Left atrial appendage orifice diameter and shape may influence occluder selection and LAAC outcomes, but the specific impact of orifice diameter with the LAmbre device needed evaluation.
Does a large LAA orifice diameter increase the risk of complications in patients with nonvalvular AF undergoing LAAC with the LAmbre device?
Cohort (n=133)
Does a large LAA orifice diameter increase the risk of complications in patients with nonvalvular AF undergoing LAAC with the LAmbre device?
While LAAC with the LAmbre device is feasible regardless of orifice size, a maximal orifice diameter ≥30 mm increases the risk of peridevice leakage and delayed pericardial effusion.
Answers are grounded in this paper and cite their sources.
Large LAA may raise delayed effusion risk with LAmbre; hypothesis-generating for device selection in oversized anatomy.
BACKGROUND: The diameter and shape of the left atrial appendage (LAA) orifices may influence occluder selection and the outcomes of left atrial appendage closure (LAAC) procedure. This study aimed to evaluate the impact of LAA orifice diameter on the safety and efficacy of LAAC using the LAmbre device. METHODS: A total of 133 patients with nonvalvular atrial fibrillation (AF) who underwent LAAC with the LAmbre device between June 2018 and June 2020 were included in this study. The patients were categorized into two groups based on the maximal diameter of the LAA orifice: the large LAA group (n = 45) with a maximal orifice diameter of ≥31 mm, and the normal LAA group (n = 88) with a maximal orifice diameter of <31 mm. The study assessed periprocedural characteristics and long-term clinical follow-up. RESULTS: Successful implantation of the LAmbre device was observed in all patients. The incidence of periprocedural peridevice leakage (PDL) was significantly higher in the large LAA group (P < 0.001), while the incidence of acute pericardial effusion (PE) during the procedure was comparable between the two groups (P = 1.000). After a mean follow-up period of 4.8 ± 1.7 years, three patients in the large LAA group developed delayed PE, while no patients in the normal LAA group did (P = 0.037). Additionally, a larger LAA maximal orifice diameter was associated with a higher prevalence of PDL (P = 0.001) and PE (including both acute and delayed PE) (P = 0.027). The optimal cutoff value of the LAA maximal orifice diameter for predicting PDL and PE after LAAC with the LAmbre device was determined to be 30 mm. CONCLUSION: The findings suggest that the LAmbre device is a safe and feasible option for occluding the LAA, regardless of its orifice diameter. However, it is important to note that a larger LAA orifice diameter may increase the risk of PDL and delayed PE.
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Zhuo et al. (2024) conducted a cohort in Nonvalvular atrial fibrillation (AF) (n=133). Large LAA (maximal orifice diameter ≥31 mm) vs. Normal LAA (maximal orifice diameter <31 mm) was evaluated on Delayed pericardial effusion (PE) (p=0.037). Left atrial appendage closure with the LAmbre device in large LAA (≥31 mm) had higher rates of delayed pericardial effusion compared to normal LAA (<31 mm).
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