Closure of Residual Left Atrial Appendage Communications After a Prior
Background: Surgical or percutaneous occlusion of the left atrial
appendage (LAA) is increasingly used for thromboembolic protection in
atrial fibrillation. Incomplete LAA closure may increase risk of
thrombosis and thromboembolism, and therefore approaches to address
residual communications are needed. Objective: To analyze the technique
of closing an incompletely occluded LAA and subsequent patient outcomes.
Methods: We performed a retrospective analysis of 5 consecutive patients
who presented for completion of LAA closure. Results: Four patients were
male, mean age 75, average CHA2DS2-VASc score 5.4, and four had prior
surgical LAA ligation. One patient had previously had a WATCHMAN device
placed for whom a 3D printed model was created from preprocedural
imaging data to guide Amplatzer occluder device selection for closure.
The residual LAA communication maximal diameter averaged 6.2 mm (range
5-8mm). In 4 of 5 cases, an ablation catheter was used to enter the LAA.
The residual LAA communication was closed with either an Amplatzer
occluder (n=3) or a WATCHMAN device (n=2). No procedural complications
occurred, and no residual leak remained afterwards. No neurologic events
occurred during follow up (average 603 days, range 155-1177 days).
Anticoagulation or dual antiplatelet therapy was stopped following a
transesophageal echo (TEE) ³ 6 weeks after the procedure demonstrated no
residual communication in 4 of 5 patients, and after 20 weeks in the
fifth patient without a follow up TEE. Conclusion: Large residual LAA
communications after LAA occlusion attempts can be successfully and
safely closed percutaneously using either Amplatzer occluder devices or