What does this research mean for the field?

Pulmonary ridge coverage during left atrial appendage occlusion is associated with a significantly lower incidence of device-related thrombosis compared to an uncovered pulmonary ridge. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 1, 2021EuroInterventionOpen Access

Pulmonary ridge coverage and device-related thrombosis after left atrial appendage occlusion

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Why the study?

The study was conducted to evaluate the impact of pulmonary ridge coverage on clinical and imaging follow-up outcomes in patients undergoing left atrial appendage occlusion.

Does pulmonary ridge coverage reduce device-related thrombosis in patients undergoing left atrial appendage occlusion?

Structured PICO

Does pulmonary ridge coverage reduce device-related thrombosis in patients undergoing left atrial appendage occlusion?

Population

147 consecutive patients with non-valvular atrial fibrillation who underwent left atrial appendage occlusion (LAAO) with disc and lobe devices.

Intervention

Left atrial appendage occlusion (LAAO) with pulmonary ridge (PR) coverage.

Comparator

Left atrial appendage occlusion (LAAO) with uncovered pulmonary ridge (PR).

Outcome

Incidence of device-related thrombosis (DRT) at follow-up.surrogate

Pulmonary ridge coverage during left atrial appendage occlusion is associated with a significantly lower incidence of device-related thrombosis.

Implication

Pulmonary ridge coverage should not yet alter LAAO technique; observational data leaves open a potential benefit warranting randomized trials.

Abstract

AIMS: The aim of this study was to evaluate the impact of pulmonary ridge (PR) coverage on both clinical and imaging follow-up outcomes in patients undergoing left atrial appendage occlusion (LAAO). METHODS AND RESULTS: The study included consecutive patients with non-valvular atrial fibrillation who underwent LAAO with disc and lobe devices. Patients were classified into two groups according to the PR coverage. A total of 147 patients were included. Among these, the PR was covered in 109 (74%) and uncovered in 38 (26%). Successful implantation was achieved in 98.6%. No differences in procedural outcomes were observed between the groups. The rate of procedural major adverse events was 3% (only major bleedings and/or vascular access complications). No device embolisation, cardiac tamponade or in-hospital mortality was observed. After a mean follow-up of 1.77±2.2 years, the annualised ischaemic stroke and major bleeding rate was 1.3%/year and 6.5%/year, respectively, without differences between groups. At follow-up, patients with a covered PR presented a lower incidence of device-related thrombosis (DRT) (1%) than those with an uncovered PR (27%); p<0.001. In multivariable analysis, the presence of PR coverage emerged as an independent predictor of DRT. CONCLUSIONS: Pulmonary ridge coverage was associated with a lower incidence of DRT after LAAO. Procedural and follow-up clinical outcomes did not differ between covered PR and uncovered PR patients.