Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes

Mesnier, J; Simard, T; Jung, RG; Lehenbauer, KR; Piayda, K; Pracon, R; Jackson, GG; Flores-Umanzor, E; Faroux, L; Korsholm, K; Chun, JKR; Chen, S; Maarse, M; Montrella, K; Chaker, Z; Spoon, JN; Pastormerlo, LE; Meincke, F; Sawant, AC; Moldovan, CM; Qintar, M; Aktas, MK; Branca, L; Radinovic, A; Ram, P; El-Zein, RS; Flautt, T; Ding, WY; Sayegh, B; Benito-González, T; Lee, OH; Badejoko, SO; Paitazoglou, C; Karim, N; Zaghloul, AM; Agarwal, H; Kaplan, RM; Alli, O; Ahmed, A; Suradi, HS; Knight, BP; Alla, VM; Panaich, SS; Wong, T; Bergmann, MW; Chothia, R; Kim, JS; Pérez de Prado, A; Bazaz, R; Gupta, D; Valderrábano, M; Sanchez, CE; El Chami, MF; Mazzone, P; Adamo, M; Ling, F; Wang, DD; O'Neill, W; Wojakowski, W; Pershad, A; Berti, S; Spoon, DB; Kawsara, A; Jabbour, G; Boersma, LVA; Schmidt, B; Nielsen-Kudsk, JE; Freixa, X; Ellis, CR; Fauchier, L; Demkow, M; Sievert, H; Main, ML; Hibbert, B; Holmes, DR; Alkhouli, M; Rodés-Cabau, J

doi:10.1016/j.jcin.2023.09.017

Arrhythmias & electrophysiology

Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes

JACC Cardiovasc IntervPublished 27 Nov 2023Multicentre registry study

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Authors' conclusion

About one-third of DRT events had an unfavorable evolution (either persisting or recurring), with a larger initial thrombus size (particularly >7 mm) portending an increased risk. Unfavorable evolution of DRT was associated with a 2-fold higher risk of thromboembolic events compared with resolved DRT.

Study context

Population: Left atrial appendage closure (LAAC) recipients with device-related thrombus and subsequent imaging after initial device-related thrombus (DRT) diagnosisof 237 with DRT
Participants: 214 recipients

Exposure: Unfavorable evolution vs resolved DRT
Unfavorable evolutionn = 75
Outcome: Incidence, predictors and clinical impact of persistent and recurrent DRT

Methodological detailsinternational

International

Main finding

As reported in the abstract

Evolution of DRT

DRT resolved

153

71.5%

DRT persisted

61

28.5%

Recurrent DRT among 82 with repeated imaging after resolution

14

17.1%

Unfavorable evolution overall

75

35.0%

Observational data: associations, not effects.

Further findings

Outcome	Unfavorable evolution	Resolved DRT	← Lower ←→ Higher →	Estimate	P value
Predictors of persistent DRTLarger DRT size (per 1-mm increase) · independent			0.20.5125	OR 1.08 (95% CI 1.02–1.15)	P = 0.009
Predictor of unfavorable evolution: average thrombus size at initial diagnosisThrombus size (per 1-mm increase) · sole predictor			0.20.5125	OR 1.09 (95% CI 1.03–1.16)	P = 0.003
Thromboembolic events	26.7%	15.1%	0.20.5125	HR 2.13 (95% CI 1.15–3.94)	P = 0.02
			0.20.5125Ratio (log scale)

Predictors of persistent DRT

	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
FemaleIndependent	0.20.5125	2.44 (1.12–5.26)	P = 0.02
	0.20.5125Odds ratio (log scale)

Predictor of unfavorable evolution: average thrombus size at initial diagnosis

	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
Size cutoff 7 mmOptimal cutoff	0.20.5125	2.51 (1.39–4.52)	P = 0.002
	0.20.5125Odds ratio (log scale)

Reference

Authors: Mesnier J, Simard T, Jung RG, Lehenbauer KR, Piayda K, Pracon R, et al.
All 77 authors
Mesnier J, Simard T, Jung RG, Lehenbauer KR, Piayda K, Pracon R, Jackson GG, Flores-Umanzor E, Faroux L, Korsholm K, Chun JKR, Chen S, Maarse M, Montrella K, Chaker Z, Spoon JN, Pastormerlo LE, Meincke F, Sawant AC, Moldovan CM, Qintar M, Aktas MK, Branca L, Radinovic A, Ram P, El-Zein RS, Flautt T, Ding WY, Sayegh B, Benito-González T, Lee OH, Badejoko SO, Paitazoglou C, Karim N, Zaghloul AM, Agarwal H, Kaplan RM, Alli O, Ahmed A, Suradi HS, Knight BP, Alla VM, Panaich SS, Wong T, Bergmann MW, Chothia R, Kim JS, Pérez de Prado A, Bazaz R, Gupta D, Valderrábano M, Sanchez CE, El Chami MF, Mazzone P, Adamo M, Ling F, Wang DD, O'Neill W, Wojakowski W, Pershad A, Berti S, Spoon DB, Kawsara A, Jabbour G, Boersma LVA, Schmidt B, Nielsen-Kudsk JE, Freixa X, Ellis CR, Fauchier L, Demkow M, Sievert H, Main ML, Hibbert B, Holmes DR, Alkhouli M, Rodés-Cabau J
Journal: JACC: Cardiovascular Interventions
Published: 27 Nov 2023
DOI: 10.1016/j.jcin.2023.09.017
PubMed: 38030358

Topic: Arrhythmias & electrophysiology

Exposure definitions

Unfavorable evolution: persisting or recurrent DRT

Original publication

Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes. JACC Cardiovasc Interv. Published 27 November 2023. doi:10.1016/j.jcin.2023.09.017

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