Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
Unsuccessful percutaneous left atrial appendage occlusion: A single center perspective.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Ahmed Adnan, Ghazal Rachad, Katapadi Aashish, Bawa Danish, Singh Vasvi, Pham Nicholas, Pothineni Naga Venkata, Darden Douglas, Gopinathannair Rakesh, Lakkireddy Dhanunjaya, Kabra Rajesh
Аннотация
BACKGROUND: Epicardial and endocardial left atrial appendage occlusion (LAAO) is commonly performed for stroke prevention for atrial fibrillation (AF) patients at increased risk for stroke who cannot tolerate long-term oral anticoagulation. However, there is limited data on the outcomes of unsuccessful LAAO procedures. This study aims to assess the incidence and outcomes of unsuccessful LAAO procedures.
METHODS: A retrospective analysis was performed on patients undergoing LAAO at our institution from 2020 to 2023. The primary endpoint was a failure to deploy the LAAO device, which was defined as unsuccessful device implantation (UDI).
RESULTS: A total of 411 patients underwent LAAO (Lariat = 6.8%, Amulet = 56.4%, and Watchman FLX/FLX Pro = 36.7%). UDI was observed in 4.9% (n = 20) of procedures. The cohort's mean age was 77.1 ± 10 years, and 45% were males. The mean CHA2DS2-VASc score was 4 ± 1.7, and the HASBLED score was 3.2 ± 1.4. The highest UDI rate was seen in Lariat (17.9%), followed by Watchman FLX (4.6%) and Amulet (2.2%). The primary reasons for UDI were unsatisfactory device positioning, inadequate depth attainment, anatomical incompatibility, and trabeculations impeding proper device placement. Among those with UDI, 40% underwent subsequent LAA closure using AtriClip, while the remainder continued oral anticoagulant as destination therapy. A small number had post-procedural complications.
CONCLUSION: LAAO demonstrates a low failure rate and is generally safe. LAA morphology significantly influences the procedure's success, with AtriClip surgical exclusion often serving as an option after UDI.
METHODS: A retrospective analysis was performed on patients undergoing LAAO at our institution from 2020 to 2023. The primary endpoint was a failure to deploy the LAAO device, which was defined as unsuccessful device implantation (UDI).
RESULTS: A total of 411 patients underwent LAAO (Lariat = 6.8%, Amulet = 56.4%, and Watchman FLX/FLX Pro = 36.7%). UDI was observed in 4.9% (n = 20) of procedures. The cohort's mean age was 77.1 ± 10 years, and 45% were males. The mean CHA2DS2-VASc score was 4 ± 1.7, and the HASBLED score was 3.2 ± 1.4. The highest UDI rate was seen in Lariat (17.9%), followed by Watchman FLX (4.6%) and Amulet (2.2%). The primary reasons for UDI were unsatisfactory device positioning, inadequate depth attainment, anatomical incompatibility, and trabeculations impeding proper device placement. Among those with UDI, 40% underwent subsequent LAA closure using AtriClip, while the remainder continued oral anticoagulant as destination therapy. A small number had post-procedural complications.
CONCLUSION: LAAO demonstrates a low failure rate and is generally safe. LAA morphology significantly influences the procedure's success, with AtriClip surgical exclusion often serving as an option after UDI.