Robotic assisted left atrial appendage exclusion in patients with atrial fibrillation and intolerance to oral anticoagulation

BACKGROUND: Oral anticoagulation (OAC) and exclusion of the left atrial appendage (LAA) greatly reduce the risk of thromboembolic events in patients with atrial fibrillation (AF). Patients with known intolerance to OAC, however, have limited options for transcatheter management of both AF and the LAA. Previous investigation has suggested that minimally invasive LAA exclusion via epicardial clip placement is feasible without OAC but is associated with variable increase in morbidity and mortality. This study aims to assess the safety and long-term efficacy of robotic-assisted LAA exclusion (RA-LAAE) in patients intolerant to OAC. METHODS: Retrospective, single-center, analysis of patients with AF and OAC intolerance that underwent RA-LAAE between 2019 and 2023. The primary objective assessed was freedom from cerebral and systemic thromboembolic events at 90 days and 1 year. Secondary outcomes included radiographic assessment of successful LAAE, rates of readmission, and overall mortality. RESULTS: Twenty-nine patients (mean age 74.6 years, 28% female), with a diagnosis of paroxysmal (48%), persistent (10%), or long-standing (41%) AF, CHA2DS2VASc 4.4±1.4, HAS-BLED 3.8±0.9, and left atrial volume index 49.1±15.2 underwent RA-LAAE. All procedures were completed successfully with an operative duration of 100±40 minutes. Postoperative length of stay was 1.7±1.3 days. Follow-up imaging at 90 days confirmed successful LAAE for all cases. MACCE within 90 days occurred in 1 (3%) patient and in no additional patients at 1 year. CONCLUSIONS: RA-LAAE in patients intolerant to OAC appears to be safe and effective with low MACCE and mortality rates.