Incidence, Predictors, and Clinical Outcomes of Device-Related Thrombus in the Amulet IDE Trial

“A heart within the heart”: A rare case of a large left atrial appendage occluder device–related thrombus

“… 5 For the Amulet subset of patients who develop DRT, the ridge of the left upper pulmonary vein was found to be uncovered in 82% of cases. 6 This finding was also highlighted by Sedaghat and colleagues, 7 who showed in their study that all thrombi were found between the device and the left upper pulmonary vein ridge, suggesting that incomplete sealing of the left atrial appendage (LAA) ostium and creation of a cul-de-sac may act as a nidus for thrombus formation. Although our patient had nonparoxysmal atrial fibrillation with device implantation of >10 mm from the pulmonary vein limbus, the pronounced cul-de-sec in this case likely was the nidus for thrombus formation.…”

“…In scenarios where this is not possible, OAC postimplant with a shorter TEE follow-up could provide guidance. 4 , 6 …”

Left atrial appendage closure: the journey today and tomorrow

“…Most DRT cases in patients with the Amulet device were detected early, within 45 days. The study also found that DRT was not associated with a higher incidence of SSE or TIA during 18 months of follow-up but was associated with more than a two-fold increase in cardiovascular death (8.7 vs. 3.9; hazard ratio of 2.33; 95% CI 1.01–5.39) [22].…”

Left Atrial Appendage Occlusion and Post-procedural Antithrombotic Management

“…Furthermore, several non-modifiable patient factors have been associated with increased DRT risk, like CHA 2 DS 2 -VASc score, age, female sex, prior stroke, non-paroxysmal AF, and reduced left ventricular ejection fraction (Table 1) [11,37,38,42]. Across studies, it appears that factors affecting flow conditions, as well as hypercoagulability disorders, appear to impact the risk, in accordance with the triad of Virchow [32,35,38]. These factors should prompt further therapeutic considerations, guiding optimization of the discharge antithrombotic regimen in the individual patient, while the bleeding risk warrants consideration.…”

“…Age [32] Female sex [32] History of stroke/TIA [33,34] High CHA 2 DS 2 -VASc [33] Non-paroxysmal AF [35,36] Hypercoagulable disorder [35] Chronic kidney disease [35] Echocardiographic parameters with LA low-flow…”