Impact of Device Implant Depth After Left Atrial Appendage Occlusion

Pedro Cepas-Guillén; Eduardo Flores-Umanzor; Nina Leduc; Vilhemas Bajoras; Nils Perrin; Julio Farjat-Pasos; Angela McInerney; Ana Lafond; Xavi Millán; Sandra Zendjebil; Gilles O'Hara; Reda Ibrahim; Ole de Backer; Ignacio Cruz-González; Dabit Arzamendi; Laura Sanchis; Philippe Garot; Jens Erik Nielsen-Kudsk; Luis Nombela-Franco; Adel Aminian; Josep Rodés-Cabau; Xavier Freixa

doi:10.1016/j.jcin.2023.05.045

Impact of Device Implant Depth After Left Atrial Appendage Occlusion

Pedro Cepas-Guillén, Eduardo Flores-Umanzor, Nina Leduc, Vilhemas Bajoras, Nils Perrin, Julio Farjat-Pasos, Angela McInerney, Ana Lafond, Xavi Millán, Sandra Zendjebil, Gilles O'Hara, Reda Ibrahim, Ole de Backer, Ignacio Cruz-González, Dabit Arzamendi, Laura Sanchis, Philippe Garot, Jens Erik Nielsen-Kudsk, Luis Nombela-Franco, Adel AminianJosep Rodés-Cabau, Xavier Freixa^*

^*Corresponding author af dette arbejde

Afdeling for Hjertesygdomme

28 Citationer (Scopus)

Abstract

BACKGROUND: Device-related thrombus (DRT) remains one of the main concerns after left atrial appendage occlusion (LAAO). Several risk factors have been proposed, but most cannot be modulated. A modifiable factor such as device implantation depth is a potential target to adjust the risk for DRT.

OBJECTIVES: The aim of this study was to assess the impact of LAAO device implantation depth as a predisposing factor for DRT.

METHODS: The study included patients who underwent successful LAAO at 9 centers in Europe and Canada. Patients were classified into 2 groups: proximal device implantation (covered pulmonary ridge [PR] in the lobe and disc cohort or <5 mm from the PR in the single-lobe cohort) and distal device implantation (uncovered PR in the disc and lobe cohort and ≥5 mm in the single-lobe cohort).

RESULTS: A total of 1,317 patients were included. Among these, proximal and distal device implantation was achieved in 732 (55%) and 585 (45%) patients, respectively. No differences in procedural outcomes were observed between the groups. At follow-up, patients with proximal implantation had a lower incidence of DRT (2.3%) than those with distal implantation (12.2%) (P < 0.001). Deeper device implantation and a larger uncovered left atrial appendage area were associated with a higher incidence of DRT (P < 0.001), regardless of device type. In multivariable analysis, distal implant (HR: 5.92; 95% CI: 3.39-10.36) and no or single antiplatelet therapy (HR: 1.62; 95% CI: 0.99-2.62) emerged as independent predictors of DRT.

CONCLUSIONS: LAAO device implantation depth is an independent risk factor for DRT. Deeper device implantation and larger uncovered left atrial appendage areas were associated with a higher incidence of DRT.

Originalsprog	Engelsk
Tidsskrift	JACC. Cardiovascular interventions
Vol/bind	16
Udgave nummer	17
Sider (fra-til)	2139-2149
Antal sider	11
ISSN	1936-8798
DOI	https://doi.org/10.1016/j.jcin.2023.05.045
Status	Udgivet - 11 sep. 2023

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Cepas-Guillén, P., Flores-Umanzor, E., Leduc, N., Bajoras, V., Perrin, N., Farjat-Pasos, J., McInerney, A., Lafond, A., Millán, X., Zendjebil, S., O'Hara, G., Ibrahim, R., de Backer, O., Cruz-González, I., Arzamendi, D., Sanchis, L., Garot, P., Nielsen-Kudsk, J. E., Nombela-Franco, L., ... Freixa, X. (2023). Impact of Device Implant Depth After Left Atrial Appendage Occlusion. JACC. Cardiovascular interventions, 16(17), 2139-2149. https://doi.org/10.1016/j.jcin.2023.05.045

Cepas-Guillén, P, Flores-Umanzor, E, Leduc, N, Bajoras, V, Perrin, N, Farjat-Pasos, J, McInerney, A, Lafond, A, Millán, X, Zendjebil, S, O'Hara, G, Ibrahim, R, de Backer, O, Cruz-González, I, Arzamendi, D, Sanchis, L, Garot, P, Nielsen-Kudsk, JE, Nombela-Franco, L, Aminian, A, Rodés-Cabau, J & Freixa, X 2023, 'Impact of Device Implant Depth After Left Atrial Appendage Occlusion', JACC. Cardiovascular interventions, bind 16, nr. 17, s. 2139-2149. https://doi.org/10.1016/j.jcin.2023.05.045

@article{6ed914253c3b436681c0dc95ded50e8b,

title = "Impact of Device Implant Depth After Left Atrial Appendage Occlusion",

abstract = "BACKGROUND: Device-related thrombus (DRT) remains one of the main concerns after left atrial appendage occlusion (LAAO). Several risk factors have been proposed, but most cannot be modulated. A modifiable factor such as device implantation depth is a potential target to adjust the risk for DRT.OBJECTIVES: The aim of this study was to assess the impact of LAAO device implantation depth as a predisposing factor for DRT.METHODS: The study included patients who underwent successful LAAO at 9 centers in Europe and Canada. Patients were classified into 2 groups: proximal device implantation (covered pulmonary ridge [PR] in the lobe and disc cohort or <5 mm from the PR in the single-lobe cohort) and distal device implantation (uncovered PR in the disc and lobe cohort and ≥5 mm in the single-lobe cohort).RESULTS: A total of 1,317 patients were included. Among these, proximal and distal device implantation was achieved in 732 (55%) and 585 (45%) patients, respectively. No differences in procedural outcomes were observed between the groups. At follow-up, patients with proximal implantation had a lower incidence of DRT (2.3%) than those with distal implantation (12.2%) (P < 0.001). Deeper device implantation and a larger uncovered left atrial appendage area were associated with a higher incidence of DRT (P < 0.001), regardless of device type. In multivariable analysis, distal implant (HR: 5.92; 95% CI: 3.39-10.36) and no or single antiplatelet therapy (HR: 1.62; 95% CI: 0.99-2.62) emerged as independent predictors of DRT.CONCLUSIONS: LAAO device implantation depth is an independent risk factor for DRT. Deeper device implantation and larger uncovered left atrial appendage areas were associated with a higher incidence of DRT.",

keywords = "Atrial Appendage/diagnostic imaging, Atrial Fibrillation/diagnostic imaging, Humans, Risk Factors, Stroke/etiology, Thrombosis/etiology, Treatment Outcome, atrial fibrillation, left atrial appendage occlusion, stroke, device-related thrombus",

author = "Pedro Cepas-Guill{\'e}n and Eduardo Flores-Umanzor and Nina Leduc and Vilhemas Bajoras and Nils Perrin and Julio Farjat-Pasos and Angela McInerney and Ana Lafond and Xavi Mill{\'a}n and Sandra Zendjebil and Gilles O'Hara and Reda Ibrahim and {de Backer}, Ole and Ignacio Cruz-Gonz{\'a}lez and Dabit Arzamendi and Laura Sanchis and Philippe Garot and Nielsen-Kudsk, {Jens Erik} and Luis Nombela-Franco and Adel Aminian and Josep Rod{\'e}s-Cabau and Xavier Freixa",

year = "2023",

month = sep,

day = "11",

doi = "10.1016/j.jcin.2023.05.045",

language = "English",

volume = "16",

pages = "2139--2149",

journal = "JACC. Cardiovascular interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "17",

}

TY - JOUR

T1 - Impact of Device Implant Depth After Left Atrial Appendage Occlusion

AU - Cepas-Guillén, Pedro

AU - Flores-Umanzor, Eduardo

AU - Leduc, Nina

AU - Bajoras, Vilhemas

AU - Perrin, Nils

AU - Farjat-Pasos, Julio

AU - McInerney, Angela

AU - Lafond, Ana

AU - Millán, Xavi

AU - Zendjebil, Sandra

AU - O'Hara, Gilles

AU - Ibrahim, Reda

AU - de Backer, Ole

AU - Cruz-González, Ignacio

AU - Arzamendi, Dabit

AU - Sanchis, Laura

AU - Garot, Philippe

AU - Nielsen-Kudsk, Jens Erik

AU - Nombela-Franco, Luis

AU - Aminian, Adel

AU - Rodés-Cabau, Josep

AU - Freixa, Xavier

PY - 2023/9/11

Y1 - 2023/9/11

N2 - BACKGROUND: Device-related thrombus (DRT) remains one of the main concerns after left atrial appendage occlusion (LAAO). Several risk factors have been proposed, but most cannot be modulated. A modifiable factor such as device implantation depth is a potential target to adjust the risk for DRT.OBJECTIVES: The aim of this study was to assess the impact of LAAO device implantation depth as a predisposing factor for DRT.METHODS: The study included patients who underwent successful LAAO at 9 centers in Europe and Canada. Patients were classified into 2 groups: proximal device implantation (covered pulmonary ridge [PR] in the lobe and disc cohort or <5 mm from the PR in the single-lobe cohort) and distal device implantation (uncovered PR in the disc and lobe cohort and ≥5 mm in the single-lobe cohort).RESULTS: A total of 1,317 patients were included. Among these, proximal and distal device implantation was achieved in 732 (55%) and 585 (45%) patients, respectively. No differences in procedural outcomes were observed between the groups. At follow-up, patients with proximal implantation had a lower incidence of DRT (2.3%) than those with distal implantation (12.2%) (P < 0.001). Deeper device implantation and a larger uncovered left atrial appendage area were associated with a higher incidence of DRT (P < 0.001), regardless of device type. In multivariable analysis, distal implant (HR: 5.92; 95% CI: 3.39-10.36) and no or single antiplatelet therapy (HR: 1.62; 95% CI: 0.99-2.62) emerged as independent predictors of DRT.CONCLUSIONS: LAAO device implantation depth is an independent risk factor for DRT. Deeper device implantation and larger uncovered left atrial appendage areas were associated with a higher incidence of DRT.

AB - BACKGROUND: Device-related thrombus (DRT) remains one of the main concerns after left atrial appendage occlusion (LAAO). Several risk factors have been proposed, but most cannot be modulated. A modifiable factor such as device implantation depth is a potential target to adjust the risk for DRT.OBJECTIVES: The aim of this study was to assess the impact of LAAO device implantation depth as a predisposing factor for DRT.METHODS: The study included patients who underwent successful LAAO at 9 centers in Europe and Canada. Patients were classified into 2 groups: proximal device implantation (covered pulmonary ridge [PR] in the lobe and disc cohort or <5 mm from the PR in the single-lobe cohort) and distal device implantation (uncovered PR in the disc and lobe cohort and ≥5 mm in the single-lobe cohort).RESULTS: A total of 1,317 patients were included. Among these, proximal and distal device implantation was achieved in 732 (55%) and 585 (45%) patients, respectively. No differences in procedural outcomes were observed between the groups. At follow-up, patients with proximal implantation had a lower incidence of DRT (2.3%) than those with distal implantation (12.2%) (P < 0.001). Deeper device implantation and a larger uncovered left atrial appendage area were associated with a higher incidence of DRT (P < 0.001), regardless of device type. In multivariable analysis, distal implant (HR: 5.92; 95% CI: 3.39-10.36) and no or single antiplatelet therapy (HR: 1.62; 95% CI: 0.99-2.62) emerged as independent predictors of DRT.CONCLUSIONS: LAAO device implantation depth is an independent risk factor for DRT. Deeper device implantation and larger uncovered left atrial appendage areas were associated with a higher incidence of DRT.

KW - Atrial Appendage/diagnostic imaging

KW - Atrial Fibrillation/diagnostic imaging

KW - Humans

KW - Risk Factors

KW - Stroke/etiology

KW - Thrombosis/etiology

KW - Treatment Outcome

KW - atrial fibrillation

KW - left atrial appendage occlusion

KW - stroke

KW - device-related thrombus

UR - http://www.scopus.com/inward/record.url?scp=85168926869&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2023.05.045

DO - 10.1016/j.jcin.2023.05.045

M3 - Journal article

C2 - 37565966

SN - 1936-8798

VL - 16

SP - 2139

EP - 2149

JO - JACC. Cardiovascular interventions

JF - JACC. Cardiovascular interventions

IS - 17

ER -

Impact of Device Implant Depth After Left Atrial Appendage Occlusion

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