Key result
Left atrial appendage occlusion was successful in 97% of patients with a 5.9% major complication rate, and MDCT showed similar peridevice flow compared to TEE at 6 weeks (1.1 vs 1.5 mm, P=0.25).
Why the study?
Is LAA occlusion safe and effective during long-term follow-up, and how does MDCT compare to TEE for assessing peridevice flow?
Observational (n=135)
No
Is LAA occlusion safe and effective during long-term follow-up, and how does MDCT compare to TEE for assessing peridevice flow?
Answers are grounded in this paper and cite their sources.
LAA occlusion has an acceptable long-term safety profile, electrical cardioversion post-closure is feasible, and MDCT is a viable alternative to TEE for evaluating peridevice flow.
Aims The use of left atrial appendage (LAA) occluders in atrial fibrillation is increasing. There are few data on the comparison between transesophageal echocardiography (TEE) and computed tomography (MDCT) assessing peridevice flow and outcome of electrical cardioversion (ECV) in these patients. Methods and results Single‐center prospective registry from 2009 to 2015 including all LAA occluders to analyze success and complications during implantation and follow‐up. Patients having ≥1 ECV were further analyzed. TEE was performed during implantation and at 6 weeks. In a subgroup of 77 patients, we compared MDCT with TEE at 6 weeks. Overall, 135 patients (69 ± 9 years; 70% male; CHA 2 DS 2 ‐VASc score: 3.6 ± 1.4; HAS‐BLED score: 2.5 ± 0.6) received a LAA occluder (Watchman, n = 73; ACP‐1, n = 59; Amulet, n = 3; PVI + LAA occluder, n = 91; and LAA occluder only, n = 44). Device implantation was successful in 131 (97%). Eight patients (5.9%) had major periprocedural complications (ischemic stroke/transient ischemic attacks, n = 4, tamponade, n = 2, device thrombosis, n = 2, Dressler syndrome, n = 1). The periprocedural complication rate was similar between concomitant procedure and LAA occluder only (8/91 vs. 5/44; P = 0.6). Twelve patients (9%) died (procedure‐related, n = 2; 1%) during follow‐up of 44 months (IQR: 43). MDCT (n = 77) at 6 weeks showed similar peridevice flow compared to TEE (TEE: 1.5 ± 1.9 mm vs. MDCT: 1.1 ± 2.2 mm, P = 0.25). Thromboembolic events occurred in 3 patients (CVA, n = 1; TIA, n = 2) during follow‐up. In total, 41 ECV were performed in 26 patients (1.6 ± 0.9/patient), 13 months (IQR: 24) after implantation (<1 month: n = 8). No ECV‐related clinical complications were observed. Conclusion LAA occlusion is feasible with an acceptable safety profile and few events during long‐term follow‐up. ECV after LAA occlusion is feasible. MDCT could help to evaluate peridevice flow.
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Berte et al. (2017) conducted an observational in Atrial fibrillation (n=135). Left atrial appendage (LAA) occlusion was evaluated on Device implantation success. Left atrial appendage occlusion was successful in 97% of patients with a 5.9% major complication rate, and MDCT showed similar peridevice flow compared to TEE at 6 weeks (1.1 vs 1.5 mm, P=0.25).
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