Arrhythmias & electrophysiology
Concomitant Mechanical Aspiration and Appendage Closure for Recalcitrant Left Atrial Appendage Thrombi
Authors' conclusion
This cases series found that temporary cerebral protection, percutaneous mechanical vacuum thrombectomy, and mechanical LAA closure was feasible in patients with persistent LAA thrombus despite optimal OAC.
Study context
- Population
- Patients with atrial fibrillation (AF) and persistent left atrial appendage (LAA) thrombus despite optimal oral anticoagulation (OAC), with contraindications to OAC; Mount Sinai Hospital, August 2023 to July 2024
- Participants
- 9 patients
- Outcome
- Patient demographic, clinical and intervention data
Methodological detailsdescriptive, consecutive patients, single-centre, cerebral protection device (CPD) not placed in 1 patient (prohibitive aortic arch anatomy); procedure went ahead without CPD after a risk-benefit assessment
- Descriptive
- Consecutive patients
- Single-centre
- CPD not placed in 1 patient (prohibitive aortic arch anatomy); procedure went ahead without CPD after a risk-benefit assessment
Main finding
As reported in the abstract
- Complete thrombus removal followed by successful LAA closure (LAAC) device placement
- 8 patients
- Small residual distal thrombus, compressed against the wall with the LAAC device
- 1 patient
- CPD placed
- 8 patients
- Balloon atrial septostomy performed
- 8 patients
- Small thrombus fragment recovered from the CPD postprocedure
- 1 patient
Observational data: associations, not effects.
Safety
Complications (index procedure and follow-up, range 4-15 months)
- No complications during index procedure or follow-up
Original publication
Concomitant Mechanical Aspiration and Appendage Closure for Recalcitrant Left Atrial Appendage Thrombi. JAMA Cardiol. Published 1 May 2025. doi:10.
Summarised from the published abstract; every number is checked against it