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

Jules Mesnier; Trevor Simard; Richard G. Jung; Kyle R. Lehenbauer; Kerstin Piayda; Radoslaw Pracon; Gregory G. Jackson; Eduardo Flores-Umanzor; Laurent Faroux; Kasper Korsholm; Julian K.R. Chun; Shaojie Chen; Moniek Maarse; Kristi Montrella; Zakeih Chaker; Jocelyn N. Spoon; Luigi E. Pastormerlo; Felix Meincke; Abhishek C. Sawant; Carmen M. Moldovan; Mohammed Qintar; Mehmet K. Aktas; Luca Branca; Andrea Radinovic; Pradhum Ram; Rayan S. El-Zein; Thomas Flautt; Wern Yew Ding; Bassel Sayegh; Tomás Benito-González; Oh Hyun Lee; Solomon O. Badejoko; Christina Paitazoglou; Nabeela Karim; Ahmed M. Zaghloul; Himanshu Agarwal; Rachel M. Kaplan; Oluseun Alli; Aamir Ahmed; Hussam S. Suradi; Bradley P. Knight; Venkata M. Alla; Sidakpal S. Panaich; Tom Wong; Martin W. Bergmann; Rashaad Chothia; Jung Sun Kim; Armando Pérez de Prado; Raveen Bazaz; Dhiraj Gupta; Miguel Valderrábano; Carlos E. Sanchez; Mikhael F. El Chami; Patrizio Mazzone; Marianna Adamo; Fred Ling; Dee Dee Wang; William O'Neill; Wojtek Wojakowski; Ashish Pershad; Sergio Berti; Daniel B. Spoon; Akram Kawsara; George Jabbour; Lucas V.A. Boersma; Boris Schmidt; Jens Erik Nielsen-Kudsk; Xavier Freixa; Christopher R. Ellis; Laurent Fauchier; Marcin Demkow; Horst Sievert; Michael L. Main; Benjamin Hibbert; David R. Holmes; Mohamad Alkhouli; Josep Rodés-Cabau

doi:10.1016/j.jcin.2023.09.017

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

Jules Mesnier, Trevor Simard, Richard G. Jung, Kyle R. Lehenbauer, Kerstin Piayda, Radoslaw Pracon, Gregory G. Jackson, Eduardo Flores-Umanzor, Laurent Faroux, Kasper Korsholm, Julian K.R. Chun, Shaojie Chen, Moniek Maarse, Kristi Montrella, Zakeih Chaker, Jocelyn N. Spoon, Luigi E. Pastormerlo, Felix Meincke, Abhishek C. Sawant, Carmen M. MoldovanMohammed Qintar, Mehmet K. Aktas, Luca Branca, Andrea Radinovic, Pradhum Ram, Rayan S. El-Zein, Thomas Flautt, Wern Yew Ding, Bassel Sayegh, Tomás Benito-González, Oh Hyun Lee, Solomon O. Badejoko, Christina Paitazoglou, Nabeela Karim, Ahmed M. Zaghloul, Himanshu Agarwal, Rachel M. Kaplan, Oluseun Alli, Aamir Ahmed, Hussam S. Suradi, Bradley P. Knight, Venkata M. Alla, Sidakpal S. Panaich, Tom Wong, Martin W. Bergmann, Rashaad Chothia, Jung Sun Kim, Armando Pérez de Prado, Raveen Bazaz, Dhiraj Gupta, Miguel Valderrábano, Carlos E. Sanchez, Mikhael F. El Chami, Patrizio Mazzone, Marianna Adamo, Fred Ling, Dee Dee Wang, William O'Neill, Wojtek Wojakowski, Ashish Pershad, Sergio Berti, Daniel B. Spoon, Akram Kawsara, George Jabbour, Lucas V.A. Boersma, Boris Schmidt, Jens Erik Nielsen-Kudsk, Xavier Freixa, Christopher R. Ellis, Laurent Fauchier, Marcin Demkow, Horst Sievert, Michael L. Main, Benjamin Hibbert, David R. Holmes, Mohamad Alkhouli, Josep Rodés-Cabau

Cardiovascular Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Scarce data exist on the evolution of device-related thrombus (DRT) after left atrial appendage closure (LAAC). Objectives: This study sought to assess the incidence, predictors, and clinical impact of persistent and recurrent DRT in LAAC recipients. Methods: Data were obtained from an international multicenter registry including 237 patients diagnosed with DRT after LAAC. Of these, 214 patients with a subsequent imaging examination after the initial diagnosis of DRT were included. Unfavorable evolution of DRT was defined as either persisting or recurrent DRT. Results: DRT resolved in 153 (71.5%) cases and persisted in 61 (28.5%) cases. Larger DRT size (OR per 1-mm increase: 1.08; 95% CI: 1.02-1.15; P = 0.009) and female (OR: 2.44; 95% CI: 1.12-5.26; P = 0.02) were independently associated with persistent DRT. After DRT resolution, 82 (53.6%) of 153 patients had repeated device imaging, with 14 (17.1%) cases diagnosed with recurrent DRT. Overall, 75 (35.0%) patients had unfavorable evolution of DRT, and the sole predictor was average thrombus size at initial diagnosis (OR per 1-mm increase: 1.09; 95% CI: 1.03-1.16; P = 0.003), with an optimal cutoff size of 7 mm (OR: 2.51; 95% CI: 1.39-4.52; P = 0.002). Unfavorable evolution of DRT was associated with a higher rate of thromboembolic events compared with resolved DRT (26.7% vs 15.1%; HR: 2.13; 95% CI: 1.15-3.94; P = 0.02). Conclusions: 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.

Original language	English (US)
Pages (from-to)	2722-2732
Number of pages	11
Journal	JACC: Cardiovascular Interventions
Volume	16
Issue number	22
DOIs	https://doi.org/10.1016/j.jcin.2023.09.017
State	Published - Nov 27 2023

Keywords

atrial fibrillation
device-related thrombus
left atrial appendage occlusion
stroke

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jcin.2023.09.017

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Mesnier, J., Simard, T., Jung, R. G., Lehenbauer, K. R., Piayda, K., Pracon, R., Jackson, G. G., Flores-Umanzor, E., Faroux, L., Korsholm, K., Chun, J. K. R., Chen, S., Maarse, M., Montrella, K., Chaker, Z., Spoon, J. N., Pastormerlo, L. E., Meincke, F., Sawant, A. C., ... Rodés-Cabau, J. (2023). Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes. JACC: Cardiovascular Interventions, 16(22), 2722-2732. https://doi.org/10.1016/j.jcin.2023.09.017

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 2023, 'Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes', JACC: Cardiovascular Interventions, vol. 16, no. 22, pp. 2722-2732. https://doi.org/10.1016/j.jcin.2023.09.017

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

abstract = "Background: Scarce data exist on the evolution of device-related thrombus (DRT) after left atrial appendage closure (LAAC). Objectives: This study sought to assess the incidence, predictors, and clinical impact of persistent and recurrent DRT in LAAC recipients. Methods: Data were obtained from an international multicenter registry including 237 patients diagnosed with DRT after LAAC. Of these, 214 patients with a subsequent imaging examination after the initial diagnosis of DRT were included. Unfavorable evolution of DRT was defined as either persisting or recurrent DRT. Results: DRT resolved in 153 (71.5%) cases and persisted in 61 (28.5%) cases. Larger DRT size (OR per 1-mm increase: 1.08; 95% CI: 1.02-1.15; P = 0.009) and female (OR: 2.44; 95% CI: 1.12-5.26; P = 0.02) were independently associated with persistent DRT. After DRT resolution, 82 (53.6%) of 153 patients had repeated device imaging, with 14 (17.1%) cases diagnosed with recurrent DRT. Overall, 75 (35.0%) patients had unfavorable evolution of DRT, and the sole predictor was average thrombus size at initial diagnosis (OR per 1-mm increase: 1.09; 95% CI: 1.03-1.16; P = 0.003), with an optimal cutoff size of 7 mm (OR: 2.51; 95% CI: 1.39-4.52; P = 0.002). Unfavorable evolution of DRT was associated with a higher rate of thromboembolic events compared with resolved DRT (26.7% vs 15.1%; HR: 2.13; 95% CI: 1.15-3.94; P = 0.02). Conclusions: 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.",

keywords = "atrial fibrillation, device-related thrombus, left atrial appendage occlusion, stroke",

author = "Jules Mesnier and Trevor Simard and Jung, {Richard G.} and Lehenbauer, {Kyle R.} and Kerstin Piayda and Radoslaw Pracon and Jackson, {Gregory G.} and Eduardo Flores-Umanzor and Laurent Faroux and Kasper Korsholm and Chun, {Julian K.R.} and Shaojie Chen and Moniek Maarse and Kristi Montrella and Zakeih Chaker and Spoon, {Jocelyn N.} and Pastormerlo, {Luigi E.} and Felix Meincke and Sawant, {Abhishek C.} and Moldovan, {Carmen M.} and Mohammed Qintar and Aktas, {Mehmet K.} and Luca Branca and Andrea Radinovic and Pradhum Ram and El-Zein, {Rayan S.} and Thomas Flautt and Ding, {Wern Yew} and Bassel Sayegh and Tom{\'a}s Benito-Gonz{\'a}lez and Lee, {Oh Hyun} and Badejoko, {Solomon O.} and Christina Paitazoglou and Nabeela Karim and Zaghloul, {Ahmed M.} and Himanshu Agarwal and Kaplan, {Rachel M.} and Oluseun Alli and Aamir Ahmed and Suradi, {Hussam S.} and Knight, {Bradley P.} and Alla, {Venkata M.} and Panaich, {Sidakpal S.} and Tom Wong and Bergmann, {Martin W.} and Rashaad Chothia and Kim, {Jung Sun} and {P{\'e}rez de Prado}, Armando and Raveen Bazaz and Dhiraj Gupta and Miguel Valderr{\'a}bano and Sanchez, {Carlos E.} and {El Chami}, {Mikhael F.} and Patrizio Mazzone and Marianna Adamo and Fred Ling and Wang, {Dee Dee} and William O'Neill and Wojtek Wojakowski and Ashish Pershad and Sergio Berti and Spoon, {Daniel B.} and Akram Kawsara and George Jabbour and Boersma, {Lucas V.A.} and Boris Schmidt and Nielsen-Kudsk, {Jens Erik} and Xavier Freixa and Ellis, {Christopher R.} and Laurent Fauchier and Marcin Demkow and Horst Sievert and Main, {Michael L.} and Benjamin Hibbert and Holmes, {David R.} and Mohamad Alkhouli and Josep Rod{\'e}s-Cabau",

note = "Publisher Copyright: {\textcopyright} 2023 American College of Cardiology Foundation",

year = "2023",

month = nov,

day = "27",

doi = "10.1016/j.jcin.2023.09.017",

language = "English (US)",

volume = "16",

pages = "2722--2732",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "22",

}

TY - JOUR

T1 - Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure

T2 - Incidence, Predictors, and Outcomes

AU - Mesnier, Jules

AU - Simard, Trevor

AU - Jung, Richard G.

AU - Lehenbauer, Kyle R.

AU - Piayda, Kerstin

AU - Pracon, Radoslaw

AU - Jackson, Gregory G.

AU - Flores-Umanzor, Eduardo

AU - Faroux, Laurent

AU - Korsholm, Kasper

AU - Chun, Julian K.R.

AU - Chen, Shaojie

AU - Maarse, Moniek

AU - Montrella, Kristi

AU - Chaker, Zakeih

AU - Spoon, Jocelyn N.

AU - Pastormerlo, Luigi E.

AU - Meincke, Felix

AU - Sawant, Abhishek C.

AU - Moldovan, Carmen M.

AU - Qintar, Mohammed

AU - Aktas, Mehmet K.

AU - Branca, Luca

AU - Radinovic, Andrea

AU - Ram, Pradhum

AU - El-Zein, Rayan S.

AU - Flautt, Thomas

AU - Ding, Wern Yew

AU - Sayegh, Bassel

AU - Benito-González, Tomás

AU - Lee, Oh Hyun

AU - Badejoko, Solomon O.

AU - Paitazoglou, Christina

AU - Karim, Nabeela

AU - Zaghloul, Ahmed M.

AU - Agarwal, Himanshu

AU - Kaplan, Rachel M.

AU - Alli, Oluseun

AU - Ahmed, Aamir

AU - Suradi, Hussam S.

AU - Knight, Bradley P.

AU - Alla, Venkata M.

AU - Panaich, Sidakpal S.

AU - Wong, Tom

AU - Bergmann, Martin W.

AU - Chothia, Rashaad

AU - Kim, Jung Sun

AU - Pérez de Prado, Armando

AU - Bazaz, Raveen

AU - Gupta, Dhiraj

AU - Valderrábano, Miguel

AU - Sanchez, Carlos E.

AU - El Chami, Mikhael F.

AU - Mazzone, Patrizio

AU - Adamo, Marianna

AU - Ling, Fred

AU - Wang, Dee Dee

AU - O'Neill, William

AU - Wojakowski, Wojtek

AU - Pershad, Ashish

AU - Berti, Sergio

AU - Spoon, Daniel B.

AU - Kawsara, Akram

AU - Jabbour, George

AU - Boersma, Lucas V.A.

AU - Schmidt, Boris

AU - Nielsen-Kudsk, Jens Erik

AU - Freixa, Xavier

AU - Ellis, Christopher R.

AU - Fauchier, Laurent

AU - Demkow, Marcin

AU - Sievert, Horst

AU - Main, Michael L.

AU - Hibbert, Benjamin

AU - Holmes, David R.

AU - Alkhouli, Mohamad

AU - Rodés-Cabau, Josep

PY - 2023/11/27

Y1 - 2023/11/27

N2 - Background: Scarce data exist on the evolution of device-related thrombus (DRT) after left atrial appendage closure (LAAC). Objectives: This study sought to assess the incidence, predictors, and clinical impact of persistent and recurrent DRT in LAAC recipients. Methods: Data were obtained from an international multicenter registry including 237 patients diagnosed with DRT after LAAC. Of these, 214 patients with a subsequent imaging examination after the initial diagnosis of DRT were included. Unfavorable evolution of DRT was defined as either persisting or recurrent DRT. Results: DRT resolved in 153 (71.5%) cases and persisted in 61 (28.5%) cases. Larger DRT size (OR per 1-mm increase: 1.08; 95% CI: 1.02-1.15; P = 0.009) and female (OR: 2.44; 95% CI: 1.12-5.26; P = 0.02) were independently associated with persistent DRT. After DRT resolution, 82 (53.6%) of 153 patients had repeated device imaging, with 14 (17.1%) cases diagnosed with recurrent DRT. Overall, 75 (35.0%) patients had unfavorable evolution of DRT, and the sole predictor was average thrombus size at initial diagnosis (OR per 1-mm increase: 1.09; 95% CI: 1.03-1.16; P = 0.003), with an optimal cutoff size of 7 mm (OR: 2.51; 95% CI: 1.39-4.52; P = 0.002). Unfavorable evolution of DRT was associated with a higher rate of thromboembolic events compared with resolved DRT (26.7% vs 15.1%; HR: 2.13; 95% CI: 1.15-3.94; P = 0.02). Conclusions: 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.

AB - Background: Scarce data exist on the evolution of device-related thrombus (DRT) after left atrial appendage closure (LAAC). Objectives: This study sought to assess the incidence, predictors, and clinical impact of persistent and recurrent DRT in LAAC recipients. Methods: Data were obtained from an international multicenter registry including 237 patients diagnosed with DRT after LAAC. Of these, 214 patients with a subsequent imaging examination after the initial diagnosis of DRT were included. Unfavorable evolution of DRT was defined as either persisting or recurrent DRT. Results: DRT resolved in 153 (71.5%) cases and persisted in 61 (28.5%) cases. Larger DRT size (OR per 1-mm increase: 1.08; 95% CI: 1.02-1.15; P = 0.009) and female (OR: 2.44; 95% CI: 1.12-5.26; P = 0.02) were independently associated with persistent DRT. After DRT resolution, 82 (53.6%) of 153 patients had repeated device imaging, with 14 (17.1%) cases diagnosed with recurrent DRT. Overall, 75 (35.0%) patients had unfavorable evolution of DRT, and the sole predictor was average thrombus size at initial diagnosis (OR per 1-mm increase: 1.09; 95% CI: 1.03-1.16; P = 0.003), with an optimal cutoff size of 7 mm (OR: 2.51; 95% CI: 1.39-4.52; P = 0.002). Unfavorable evolution of DRT was associated with a higher rate of thromboembolic events compared with resolved DRT (26.7% vs 15.1%; HR: 2.13; 95% CI: 1.15-3.94; P = 0.02). Conclusions: 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.

KW - atrial fibrillation

KW - device-related thrombus

KW - left atrial appendage occlusion

KW - stroke

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UR - http://www.scopus.com/inward/citedby.url?scp=85176441735&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2023.09.017

DO - 10.1016/j.jcin.2023.09.017

M3 - Article

C2 - 38030358

AN - SCOPUS:85176441735

SN - 1936-8798

VL - 16

SP - 2722

EP - 2732

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 22

ER -

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

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