1. Long-Term Imaging and Clinical Outcomes of Surgical Left Atrial Appendage Occlusion With AtriClip.
- Author
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Ahmed A, Pothineni NVK, Singh V, Bawa D, Darden D, Kabra R, Singh A, Memon S, Romeya A, Van Meeteren J, Thambidorai S, Lakkireddy D, and Gopinathannair R
- Subjects
- Humans, Male, Female, Retrospective Studies, Treatment Outcome, Echocardiography, Transesophageal adverse effects, Atrial Appendage diagnostic imaging, Atrial Appendage surgery, Cardiac Surgical Procedures methods, Stroke epidemiology, Stroke etiology, Stroke prevention & control, Atrial Fibrillation complications, Atrial Fibrillation surgery
- Abstract
Surgical left atrial appendage (LAA) occlusion with an AtriClip (AtriCure, West Chester, Ohio) is frequently performed for stroke prophylaxis in patients with atrial fibrillation (AF). We conducted a retrospective analysis of all patients with long-standing persistent AF who underwent hybrid convergent ablation and LAA clipping. Contrast-enhanced cardiac computed tomography was performed at 3 to 6 months after LAA clipping to assess the degree of complete closure and the residual LAA stump. A total of 78 patients (64 ± 10 years, 72% male) underwent LAA clipping as part of hybrid convergent AF ablation, from 2019 to 2020. Median size of AtriClip used was 45 mm. Mean LA size was 4.6 ± 1 cm. At 3-to-6 months follow-up computed tomography, 46.2% of patients (n = 36) had a residual stump proximal to the deployed LAA clip. Mean depth of residual stump was 3.95 ± 5.5 mm, with 19% of patients (n = 15) having a stump depth of ≥10 mm and 1 patient requiring more endocardial LAA closure owing to large stump depth. During 1-year follow-up, 3 patients developed stroke; device leak of 6 mm was noted in 1 patient; and none of the patients had a thrombus proximal to the clip. In conclusion, high incidence of residual LAA stump was observed with AtriClip. Larger studies with long-term follow-up are needed to better assess the thromboembolic implications of a residual stump after AtriClip placement., Competing Interests: Declaration of Competing Interest Dr. Pothenini reports speaking honorarium from Boston Scientific. Dr. Singh reports research grant—American Society of Nuclear Cardiology and Pfizer; Advisory Board—Pfizer; and speaker bureau—Pfizer. Dr. Lakkireddy reports being consultant to Bionsense Webster, Boston Scientific, Abbott, AtriCure, Alta Thera, Phillips, and Acutus. Dr. Gopinathannair reports consultancy/honoraria—Abbott Medical and Sanofi; and being on the advisory board of Pacemate. The remaining authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Published
- 2023
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