Outcome of left atrial appendage occlusion in high-risk patients

Research output: Contribution to journalArticle

Authors

  • Ahmed Masoud
  • Stefano Bartoletti
  • Timothy Fairbairn
  • Ayush Khurana
  • Periaswamy Velavan
  • William Lindsay Morrison
  • Afshin Khalatbari
  • Suneil Aggarwal
  • Nikhill Sharma
  • Dhiraj Gupta

Colleges, School and Institutes

External organisations

  • Department of Cardiology, Benha University, Benha, Egypt.
  • Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.
  • Department for Stroke, Gerontology and General Internal Medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
  • Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.

Abstract

OBJECTIVE: Percutaneous left atrial appendage (LAA) occlusion can be an interventional alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation.

METHODS: We delivered LAA occlusion therapy using a standardised approach to patient referral, multidisciplinary team assessment, implant criteria, imaging and follow-up. We analysed patient characteristics, efficacy and safety of the implant procedure, and 12-month outcomes.

RESULTS: Of 143 referrals from October 2014 to December 2016, 83 patients (age 76±8years, 32.5% female, mean CHAD2S2-VASc score 4 ±1) were offered LAA occlusion. Eighty (95.3%) had previous major bleeding (intracranial in 59%). LAA occluder implantation with an Amulet device was successful in 82 (98.8%), with periprocedural major adverse events occurring in 5 (6.0%) patients (2 device embolisations including 1 death, 2 major bleeds). Cardiac imaging in 75 (94%) patients 2months following implant showed device-related thrombus in 1 case (1.3%) and minor (<5mm) device leaks in 13 (17.1%). Over a median 12-month follow-up, 3 (3.8%) ischaemic strokes, 2 (2.5%) haemorrhagic strokes and 5 (6.3%) major extracranial bleeds occurred. All-cause mortality was 10%, with most deaths (7, 87.5%) due to non-cardiovascular causes.

CONCLUSIONS: LAA occlusion may be a reasonable option for stroke prevention inhigh-risk patients with atrial fibrillation ineligible for anticoagulation. However, procedural complication rates are not insignificant, and patients remain at risk of serious adverse events and death even after successful implant.

Details

Original languageEnglish
Pages (from-to)594-599
Number of pages6
JournalHeart
Volume104
Issue number7
Early online date9 Nov 2018
Publication statusE-pub ahead of print - 9 Nov 2018