Abstract
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) ≥ 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 WATCHMAN devices.