Clinical and echocardiographic risk factors for device-related thrombus after left atrial appendage closure: an analysis from the multicenter EUROC-DRT registry

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Vivian Vij, University of Bonn
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  • Kerstin Piayda, CardioVasculäres Centrum
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  • Dominik Nelles, University of Bonn
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  • Steffen Gloekler, Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; and.
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  • Roberto Galea, Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; and.
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  • Monika Fürholz, Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; and.
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  • Bernhard Meier, Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; and.
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  • Marco Valgimigli, Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; and.
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  • Gilles O'Hara, Univ Laval, Laval University, Dept Chem
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  • Dabit Arzamendi, Hosp Santa Creu & Sant Pau, Hospital of Santa Creu i Sant Pau, Med Dept
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  • Victor Agudelo, Hosp Santa Creu & Sant Pau, Hospital of Santa Creu i Sant Pau, Med Dept
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  • Lluis Asmarats, Univ Laval, Laval University, Dept Chem
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  • Xavier Freixa, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
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  • Eduardo Flores-Umanzor, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
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  • Ole De Backer, University of Copenhagen
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  • Lars Sondergaard, University of Copenhagen
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  • Luis Nombela-Franco, Hospital Clínico San Carlos, Madrid, Spain.
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  • Angela McInerney, Hospital Clínico San Carlos, Madrid, Spain.
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  • Kasper Korsholm
  • Jens Erik Nielsen-Kudsk
  • Shazia Afzal, Univ Klinikum Dusseldorf, Heinrich Heine University Dusseldorf Hospital, Heinrich Heine University Dusseldorf
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  • Tobias Zeus, Univ Klinikum Dusseldorf, Heinrich Heine University Dusseldorf Hospital, Heinrich Heine University Dusseldorf
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  • Felix Operhalski, Agaplesion Bethanien Krankenhaus
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  • Boris Schmidt, Agaplesion Bethanien Krankenhaus
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  • Gilles Montalescot, Surbonne University Pitié-Salpêtrière Hospital (AP-HP) Paris
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  • Paul Guedeney, Surbonne University Pitié-Salpêtrière Hospital (AP-HP) Paris
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  • Xavier Iriart, Department of Cardiology/Hypertension, University Hospital of Bordeaux, Bordeaux, France.
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  • Noelie Miton, Department of Cardiology/Hypertension, University Hospital of Bordeaux, Bordeaux, France.
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  • Jacqueline Saw, Vancouver General Hospital, Vancouver, BC, CA
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  • Thomas Gilhofer, Stadtspital Waid and Triemli
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  • Laurent Fauchier, University Hospital Tours
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  • Egzon Veliqi, Asklepios St. Georg Hospital, Hermann-Holthusen Institute for Radiotherapy, Hamburg, Germany.
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  • Felix Meincke, Asklepios St. Georg Hospital, Hermann-Holthusen Institute for Radiotherapy, Hamburg, Germany.
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  • Nils Petri, Renal Division, University of Würzburg, University Hospital, Wurzburg, Germany.
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  • Peter Nordbeck, Renal Division, University of Würzburg, University Hospital, Wurzburg, Germany.
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  • Dmitrii Ognerubov, Russian Cardiology Research and Production Complex
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  • Evgeny Merkulov, Russian Cardiology Research and Production Complex
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  • Ignacio Cruz-González, Department of Cardiology, University Hospital of Salamanca, Salamanca, Spain.
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  • Rocio Gonzalez-Ferreiro, Department of Cardiology, University Hospital of Salamanca, Salamanca, Spain.
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  • Deepak L Bhatt, Harvard School of Dental Medicine and Harvard Medical School
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  • Alessandra Laricchia, Humanitas University
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  • Antonio Mangieri, Humanitas University
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  • Heyder Omran, Marienkrankenhaus
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  • Jan Wilko Schrickel, University of Bonn
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  • Josep Rodes-Cabau, Univ Laval, Laval University, Dept Chem
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  • Horst Sievert, CardioVasculäres Centrum
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  • Georg Nickenig, University of Bonn
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  • Alexander Sedaghat, University of Bonn

BACKGROUND: Data on Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) remain scarce. This study aimed to investigate risk factors for DRT from centers reporting to the EUROC-DRT registry.

METHODS: We included 537 patients (112 with DRT and 425 without DRT) who had undergone LAAC between 12/2008 and 04/2019. Baseline and implantation characteristics, anti-thrombotic treatment and clinical outcomes were compared between both groups in uni- and multivariate analyses. Additional propensity-score matching (PSM) was conducted to focus on the role of implantation characteristics.

RESULTS: Patients with DRT showed higher rates of previous stroke/transient ischemic attack (TIA) (49.1% vs. 34.7%, p < 0.01), spontaneous echocardiographic contrast (SEC) (44.9% vs. 27.7%, p < 0.01) and lower left atrial appendage (LAA) peak emptying velocity (35.4 ± 18.5 vs. 42.4 ± 18.0 cm/s, p = 0.02). Occluders implanted in DRT patients were larger (25.5 ± 3.8 vs. 24.6 ± 3.5 mm, p = 0.03) and implanted deeper in the LAA (mean depth: 7.6 ± 4.7 vs. 5.7 ± 4.7 mm, p < 0.01). Coverage of the appendage ostium was achieved less often in DRT patients (69.5% vs. 81.5%, p < 0.01), while DRT patients were less frequently on oral anticoagulation (7.1% vs. 16.7%, p < 0.01). Multivariate analysis identified age, prior stroke/TIA and SEC as independent risk factors for DRT. After PSM, implantation depth was found to be predictive. Rates of stroke/TIA were higher in DRT patients (13.5% vs. 3.8%, Hazard Ratio: 4.21 [95%-confidence interval: 1.88-9.49], p < 0.01).

CONCLUSIONS: DRT after LAAC is associated with adverse outcome and appears to be of multifactorial origin, depending on patient characteristics, anticoagulation regimen and device position.

Original languageEnglish
JournalClinical Research in Cardiology
Volume111
Issue11
Pages (from-to)1276-1285
Number of pages10
ISSN1861-0684
DOIs
Publication statusPublished - Nov 2022

    Research areas

  • Atrial fibrillation, Device-related thrombus, Left atrial appendage closure, Stroke

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