Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Left Atrial Appendage Closure D-AB28 - Left Atrial Appendage Closure- Trials and Tribulations (ID 32) Abstract Plus

D-AB28-04 - Differences In Outcome After Left Atrial Appendage Occluder Implantation Using LAmbre Vs. Watchman: Shorter, Easier, Safer And With Better Long-term Efficacy (ID 810)

Disclosure
 A. Füting: Nothing relevant to disclose.

Abstract

Background: Percutaneous left atrial appendage (LAA) closure has been established as an alternative strategy for stroke prevention in AF patients not eligible for oral anticoagulation. Most experience has been obtained with the Watchman occluder. The novel LifeTech LAmbre occluder is specifically designed for LAA closure adaptive to various LAA anatomies.
Objective: This study compared both occluders in terms of peri-procedural and medium-term outcomes.
Methods: From 2014 until 2019, patients were included in this prospective observational study. No preprocedural imaging was performed. Transesophageal echocardiography (TEE)-guided implantation, under conscious sedation with Propofol and Midazolam, was performed by two experienced operators. Device selection was based on operators’ discretion. Device size was chosen based on angiographic and TEE measurements. Follow-up included TEE combined with an outpatient visit 3 months after implantation.
Results: The device was implanted in 182 patients (76 years, 58% male, 67% persistent AF, CHA2DS2-VASc: 4, HAS-BLED: 3). At baseline, 81% were treated with (non-vitamin K) oral anti-coagulants ((N)OAC) and 74% had at least one severe bleeding. Five patients had previously been rejected for Watchman occluder implantation by reasons of too small LAA. Implant success rate was 99% (109/110) with Watchman and 100% (72/72) with LAmbre (p = ns). Procedural and fluoroscopic times were significantly shorter with LAmbre (p = 0.033). Device repositions were significantly more common with Watchman (1.9% vs. 1.0% with LAmbre, p = 0.035). There were more peri-procedural adverse events with Watchman, especially groin hematoma and cardiac tamponade (p = 0.043). (Last) TEE follow-up after median 149 days showed a correct position in 97% (p = ns), with a peri-device leak >5 mm in 4% (6% with Watchman and 2% with LAmbre, p = 0.048). There was no stroke or systemic embolism. Nine (5%) patients died during a follow-up of median 830 days (p = ns).
Conclusion: From our 5-year experience, implantation in an old and highly morbid patient population was associated with a good success rate and clinical outcome. Implantations using LAmbre occluders were shorter, easier and safer, with better medium-term efficacy, compared to Watchman occluders.
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