Double device closure for large or bilobar left atrial appendage anatomy

Aims To assess the safety and feasibility of double device closure of large or bilobar left atrial appendages (LAAs). Methods and results Procedural details and mid-term outcomes of 8 consecutive patients who underwent LAAO with double devices were described. Mean age was 75.9±6.0 years, mean CHA2DS2VASc score was 5.3±1.4, and mean HASBLED score was 3.0±1.5. The mean minimal and maximal diameters of the LAA orifice were 20.8±6.5mm and 26.7±6.7mm, respectively. The Watchman device was the first device in all cases. The second device was Watchman in 1 patient (12.5%), and Amplatzer vascular plug- II (AVP) in 7 (87.5%). Simultaneous deployment via 2 transseptal punctures was utilized in 3 patients, and sequential deployment via a single puncture was used in the other 5. Procedural success was achieved in 100%. There were no 30-day mortality or major complications. No device-related thrombus or major peri-device leak were detected on follow-up imaging. At mid-term follow up (median=142, range=67-539 days), 1 patient died due to intra-cranial hemorrhage while on dual antiplatelets. No other major adverse events were observed. Conclusions Double device LAA occlusion may provide a feasible and effective alternative stroke prevention strategy for patients with challenging LAA anatomies that have no other feasible options.