Key result
Epicardial LAAC without antithrombotics shows low thromboembolism with ~1% cardioembolic rate over 3 years.
Why the study?
Endovascular left atrial appendage occlusion requires antithrombotic therapy, whereas epicardial appendage closure may not require it due to the absence of intracardiac foreign material, but large series data are missing.
Does standalone totally thoracoscopic epicardial appendage closure without antithrombotic therapy safely prevent cardioembolic events in patients with atrial fibrillation and poor tolerance to anticoagulants?
Observational (n=180)
No
Does standalone totally thoracoscopic epicardial appendage closure without antithrombotic therapy safely prevent cardioembolic events in patients with atrial fibrillation and poor tolerance to anticoagulants?
Standalone thoracoscopic epicardial left atrial appendage closure without post-procedural antithrombotic therapy appears safe and effective for stroke prevention in AFib patients with high bleeding risk.
Background: Left atrial appendage occlusion is an increasingly proposed treatment for patients with atrial fibrillation and poor tolerance to anticoagulants. All endovascular devices require antithrombotic therapy. Anatomical and clinical variables predisposing to device-related thrombosis, as well as post-procedural peri-device leaks, could mandate the continuation or reintroduction of aggressive antithrombotic treatment. Because of the absence of foreign material inside the heart, epicardial appendage closure possibly does not necessitate antithrombotic therapy, but data of large series are missing. Methods: Multidisciplinary team evaluation for standalone totally thoracoscopic epicardial appendage closure was done in 180 consecutive patients with atrial fibrillation and poor tolerance to antithrombotic therapy. One hundred and fifty-two patients consented (male 66.1%, mean age 76.1 ± 7.4, CHA2DS2VASc mean 5.3 ± 1.6, HASBLED mean 3.8 ± 1.1). Indications were cerebral hemorrhage (48%), gastro-intestinal bleeding (33.3%), and other bleeding (20.7%). No antithrombotic therapy was prescribed from the day of surgery to the latest follow up. Results: Procedural success was 98.7%. At a mean follow up of 38.2 ± 18.8 months, cardioembolic and bleeding events were 1.3% and 0.6%, respectively. Among patients with a history of blood transfusions (41.1%), none needed further transfusions or treatment post procedure. Conclusion: Epicardial appendage occlusion without any antithrombotic therapy appears to be safe and effective. This strategy could be advised when minimization of bleeding risk concomitant to stroke prevention is needed.
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Branzoli et al. (2022) conducted an observational in Atrial Fibrillation with poor tolerance to antithrombotic therapy (n=180). Totally thoracoscopic epicardial appendage closure without antithrombotic therapy vs. Expected risk rate / Non-consenting patients was evaluated on Cardioembolic events. Epicardial left atrial appendage closure without post-procedural antithrombotic therapy demonstrated a 1.3% cardioembolic rate and 0.6% bleeding rate over 38.2 months in patients with atrial fibrillation.
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