Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Left Atrial Appendage Closure D-PO02 - Poster Session II (ID 47) Poster

D-PO02-213 - Treatments And Outcomes Of Device-related Thrombus After A Left Atrial Appendage Closure Device (ID 257)

Disclosure
 D.H. Yoo: Nothing relevant to disclose.

Abstract

Background: Transcatheter left atrial appendage closure (LAAC) is an alternative to oral anticoagulants (OAC) for stroke prevention in atrial fibrillation (AF) patients who are not optimal candidates for long-term therapy. Device-related thrombus (DRT) is uncommon but is associated with recurrent stroke. Clinical outcomes after medical treatment for DRT have not been well studied.
Objective: To review management and outcomes of DRT in patients treated with the WATCHMAN device.
Methods: Patients who underwent WATCHMAN LAAC at our institution from 1/2013 to 10/2019 and had transesophageal echocardiogram (TEE)-confirmed DRT were selected for retrospective review.
Results: 1084 patients underwent WATCHMAN LAAC and DRT was identified in 28 patients (2.6%). The mean age of DRT patients was 80.4±7.5, CHA2DS2-VASc was 5.6±1.4, HAS-BLED was 3.4±1.1, and 35.7% had paroxysmal AF. DRT was identified on surveillance 45-day TEE in 9 patients (32.1%), 3-month TEE in 2 (7.1%), 1-year TEE in 15 (53.6%), and TEE after stroke in 2 (7.1%). The medical therapy for DRT was ASA/NOAC in 13 cases (46.4%), ASA/warfarin in 5 (17.9%), NOAC monotherapy in 6 (21.4%), DAPT in 1 (3.6%), and DAPT/warfarin in 1 (3.6%). Two cases (7.1%) received multiple OAC regimens over time. The mean clinical follow-up (FU) was 15.1±11.3 months (median 11.8, range 1.4-43). The mean duration of medical therapy for DRT was 7.2±6.4 months (median: 3.9, range: 1.4-19.2). The first TEE after DRT diagnosis was performed in 26 patients at a mean of 2.7±2 months (1 patient died prior to TEE FU and another patient was followed by cardiac CT). DRT resolved in 14 patients (51.9%) on the first FU TEE and eventually resolved in 26 patients (96.3%) over 5.3±4.4 months. DRT recurred after initial resolution in 3 patients (11.1%); all resolved again with another course of OAC. DRT did not resolve in one patient after 6 months FU but died before next TEE. Cardiovascular/unexplained death, stroke, or systemic embolism occurred in 4 patients (14.3%) over FU.
Conclusion: Although the majority of WATCHMAN-associated DRT can be successfully treated with OAC ± antiplatelet, persistent or recurrent DRT is not uncommon, highlighting the therapeutic challenge of this phenomenon and the requirement for long-term surveillance imaging.
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