Left Atrial Appendage Closure in Patients With Left Atrial Appendage Thrombus Guided by Intracardiac Echocardiography

Heart Rhythm. 2024 Jan 23:S1547-5271(24)00082-1. doi: 10.1016/j.hrthm.2024.01.028. Online ahead of print.

Abstract

Background: Data regarding left atrial appendage closure (LAAC) in patients with left atrial appendage (LAA) thrombus are limited. Recently published cases have mostly been guided by transesophageal echocardiography (TEE). Intracardiac echocardiography (ICE) is now widely used during LAAC procedures.

Objective: This is the first study to report the feasibility of LAAC in patients with LAA thrombus guided by ICE.

Methods: Patients with persistent LAA thrombus despite anticoagulation or contraindications to anticoagulation who underwent a modified ICE-guided LAAC procedure between June 2021 and April 2023 were included. Periprocedural events and clinical outcomes during follow-up were recorded.

Results: A total of 12 patients (aged 65 ± 7 years; 92% male) were included: 10 with persistent LAA thrombus and 2 with contraindications to anticoagulation. Most of the thrombus was at the apex (n = 6), followed by the body (n = 3) and the ostium (n = 3). LAmbre device was used and successfully implanted into all patients with the guidance of ICE. No thrombotic material was retrieved from patients with the protection of cerebral protection device (n = 11). No patient experienced severe periprocedural complications. All patients completed TEE follow-up, and no device-related thrombus or peridevice leakage > 3 mm was detected. None of the patients experienced stroke/TIA, systemic embolism, or major bleeding events during a median follow-up of 147 (80-306) days.

Conclusion: LAAC using the LAmbre device guided by ICE may be feasible in patients with LAA thrombus when performed by experienced operators.

Keywords: LAmbre device; Left atrial appendage closure; cerebral protection device; intracardiac echocardiography; left atrial appendage thrombus.