Clinical Outcomes following Left Atrial Appendage Occlusion: A Single-Center Experience

Abstract

Introduction: Percutaneous left atrial appendage closure is an established alternative to anticoagulation therapy for stroke prophylaxis among patients with nonvalvular atrial fibrillation. There are currently no guidelines on the choice of antithrombotic therapy following placement of the Watchman® device, the optimal time to discontinue anticoagulation or the duration of follow-up imaging after device deployment. Our main objective was to evaluate clinical outcomes among these patients. Methods: We conducted a retrospective review of patients who received a Watchman® device at Mayo Clinic sites between January 2010 and December 2018. We constructed Cox-proportional hazard models to evaluate the effect of specific variables on clinical outcomes. Results: 231 patients were identified (33% female), median age was 77 years, CHA₂DS₂-VASc score was 5 and HASBLED score was 4. We found no difference in clinically significant bleeding based on initial antithrombotic choice. However, patients with prior gastrointestinal bleeding were more likely to have a bleeding event in the first 6 weeks following Watchman® implantation (HR 9.40, 95% CI 2.15–41.09). Device sizes of 24–27 mm were significantly associated with a decreased risk of thromboembolic events (HR 0.15, 95% CI 0.04–0.55) compared to 21-mm devices. Peridevice leak (PDL) sizes appeared to either remain the same or increase on follow-up imaging. Discussion/Conclusions: This observational study showed no statistically significant difference in bleeding risk related to initial antithrombotic choice. Smaller device sizes were associated with thromboembolic events, and longitudinal PDL assessment using transesophageal echocardiography showed these frequently do not decrease in size. Larger studies are needed.

Comparison of outcomes between novel oral anticoagulants and warfarin monotherapy in patients with left atrial appendage closure: A systematic review and meta-analysis

“…Compared with previous meta-analysis comparing NOAC vs. warfarin after LAAC ( 40 ), the current report has included several updates. First, we included three additional studies meeting our criteria ( 17 , 21 , 22 ) (Freeman-2022, Ge-2022, and Adedinsewo-2020) and excluded ( 41 – 43 ), which compared NOAC+ASA vs . warfarin +ASA ( 41 – 43 ) instead of NOAC vs .…”

“…Theoretically, NOAC has fewer drugdrug interactions than warfarin and does not require a frequent blood draw to monitor the international normalized ratio (INR) (13). However, there is no consensus on the selection of novel oral anticoagulants (NOAC) and warfarin monotherapy after LAAC, and the results of clinical studies comparing the efficacy and safety of NOAC to warfarin monotherapy after LAAC were still inconclusive (14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

Electrocardiogram-Artificial Intelligence and Immune-Mediated Necrotizing Myopathy: Predicting Left Ventricular Dysfunction and Clinical Outcomes

“…We used our previously generated and validated convolutional neural network (CNN) model to determine its ability to identify LVD in our IMNM population. 16 , 18 , 19 The specifics of the model have been described in detail elsewhere. 16 , 18 The model used CNN with Keras with a Tensorflow (Google) with a dataset model generated and tested with individual echocardiograms paired with 12-lead ECGs that were obtained within a 2-week period.…”

Percutaneous Left Atrial Appendage Occlusion

“…Adedineswo et al [6] conducted a retrospective observational study of 231 patients (33% female) who received a Watchman® device at Mayo Clinic sites. Patients had high thromboembolic and bleeding risk scores.…”

“…In fact, the authors declare that 70% of patients are discharged with warfarin, 23% are discharged with NOACs, and only 7% are discharged with antiplatelet therapy. In Europe, however, most patients are discharged with antiplatelet therapy [6, 7]. On the other hand, the follow-up was short (only 45 days).…”