Clinical Electrophysiology -> Syncope & Bradycardia: -> Experimental Methods D-PO01 - Featured Poster Session (ID 11) Poster

Abstract

Background: Left atrial appendage closure (LAAC) is being increasingly used in patients with atrial fibrillation (AF) at high risk for stroke. Device related thrombus (DRT) is a rare yet serious complication.
Objective: We sought to assess the incidence and clinical outcomes of DRT in patients undergoing WatchmanTM device implant.
Methods: This is a multicenter, retrospective study of patients who received a Watchman device between January 1, 2014 and October 31, 2019 in whom DRT was diagnosed. Baseline demographic and clinical characteristics and clinical outcomes are reported. Post- device transesophageal echocardiogram was performed at 45 days, 6 and 12 months.
Results: Of 903 patients (Age 74±7 yrs; 47% female) receiving a Watchman implant at 4 centers, DRT was detected in 19 patients (2.1%) on follow-up TEE. Mean CHADS2VASc2 and HASBLED scores were 4.7±1.7 and 3.0±1.5, respectively. Mean left ventricular ejection fraction was 53.5±9.3%. Mean time from implant to DRT diagnosis was 178±144 days. At time of DRT diagnosis, 6 (32%) patients were on aspirin only, 5 (26%) were on dual antiplatelet therapy, 3 (16%) on novel oral anticoagulants (NOAC) and 4 (21%) were on warfarin and aspirin; 5/19 (26%) were treated with warfarin and 14/19 (74%) with a NOAC. Of the 19 patients, 2 experienced a thromboembolic event, one at 60 days and the other 1 year from device implant.
Conclusion: In our multicenter study, incidence of DRT was low (2.1%) as compared to the 4 (PROTECT-AF, PREVAIL, CAP CAP2) major clinical trials (3.7%). Majority of DRT were detected in patients only on aspirin. Frequency of surveillance as well as optimal management strategies for DRT following LAAC needs further study.
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