Effective Therapeutic Intervention for Left Atrial Appendage Thrombus: Percutaneous Left Atrial Appendage Closure

Objective: The thrombus formation in the left atrial appendage (LAA) can be challenging for operators and increases periprocedural complication risk. However, recent consensus documents discuss that left atrial appendage closure is a potential therapeutic option for malign left atrial appendage. This clinical study aimed to evaluate the procedural safety and early efficacy outcomes of left atrial appendage closure in patients with left atrial appendage thrombus. Methods: This observational single-center clinical trial included 18 patients with left atrial appendage thrombus. Transesophageal echocardiography was performed before and during the left atrial appendage closure in all patients. All procedures were performed using the Amplatzer Amulet left atrial appendage closure device (Abbott Medical Inc.). Results: Ten of the patients were male (55.6%). The mean ages were 69.6 ± 7.5 years. CHA2DS2-VASc and HAS-BLED scores were calculated at 5 (2-8) and 3 (1-6), respectively. In 4 patients (22.2%), left atrial appendage occlusion was indicated due to malign left atrial appendage. The significant bleeding event under oral anticoagulant treatment was the main indication in 12 patients (66.7%). All patients were referred to Transthoracic Echocardiography (TTE) and transesophageal echocardiography 30 days after the procedure. There were no major or minor adverse clinical events during the first month of follow-up. Also, no patient faced ischemic cerebrovascular events, including transient ischemic attack, hospitalization due to heart failure, or significant bleeding events. Neither device-related thrombus nor peridevice leak was observed in the Transesophageal echocardiography evaluation. Conclusions: Left atrial appendage closure in patients with left atrial appendage thrombus is a feasible and effective method to reduce thromboembolic risk. It can be performed as an alternative therapy to oral anticoagulants (OACs) in patients with contraindications to OACs or malign left atrial appendage.