Key result
Percutaneous left atrial appendage closure in 5 patients with HHT and AF resulted in no peri-procedural complications, but 2 patients (40%) experienced thromboembolic events by 12 months.
Why the study?
Does percutaneous LAA closure prevent thromboembolic events in patients with HHT and high-risk AF who are intolerant to oral anticoagulation?
Case Report (n=5)
Does percutaneous LAA closure prevent thromboembolic events in patients with HHT and high-risk AF who are intolerant to oral anticoagulation?
Percutaneous LAA closure may be a feasible alternative to oral anticoagulation in patients with HHT and AF, though thromboembolic events can still occur, particularly in those with pulmonary right-to-left shunts.
High event rate after LAA closure in HHT-AF warrants caution; hypothesis-generating and requires prospective trials before adoption.
Many patients with hereditary hemorrhagic telangiectasia (HHT) are unable to sustain oral anticoagulation (OAC) because of severe epistaxis, gastrointestinal (GI) bleeding and the risk of life-threatening bleeding from cerebral arteriovenous malformations (CAVMs) or pulmonary arteriovenous malformations (PAVMs). In patients with atrial fibrillation (AF), most thromboembolic complications arise from the left atrial appendage (LAA) and percutaneous transcatheter LAA closure proved to be non-inferior to OAC at mid-term follow-up. We report our experience with LAA closure in HHT with a follow-up of 12 months. Percutaneous LAA closure was performed in five patients with both HHT and high thromboembolic risk AF (CHA2DS2-VASc score ≥2) without peri-procedural complications. At 3 months no thromboembolic event occurred. After 12 months one patient had a transient ischemic attack while another patient had recurrence of stroke, this latter patient had a significant stenosis of the carotid artery and an incomplete closure of the LAA without any signs of thrombus on echocardiogram. Both patients had a non-treatable pulmonary right-to-left shunt (RLS). Percutaneous closure of the LAA may provide an alternative strategy to long-term OAC therapy in HHT patients with AF induced high stroke risk and intolerance for OAC.
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Vorselaars et al. (2015) conducted a case report in Hereditary hemorrhagic telangiectasia and atrial fibrillation (n=5). Percutaneous left atrial appendage closure was evaluated on Thromboembolic events at 12 months. Percutaneous left atrial appendage closure in 5 patients with HHT and AF resulted in no peri-procedural complications, but 2 patients (40%) experienced thromboembolic events by 12 months.
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