Experience of Combined Procedure During Percutaneous Left Atrial
Appendage Closure.
Abstract
Introduction: Percutaneous left atrial appendage closure (LAAC) is an
alternative to oral anticoagulant (OAC) in patients with non-valvular
atrial fibrillation (AF) and contraindication to long-term OAC. Combined
strategy with percutaneous LAAC at the same time of other cardiac
structural or electrophysiological procedure has emerged as an
alternative to staged strategy. Aim: To describe our experience of
combined LAAC procedures using Watchman™ devices. Method: All patients
with combined LAAC procedure using Watchman™ (WN) devices performed from
2016-2021 were included. The primary safety endpoint was a composite of
periprocedural complications and adverse events during follow-up. The
primary efficacy endpoint included strokes, systemic embolisms, major
bleeding, and cardiovascular death. Results: Since 2016, among the 157
patients who underwent LAAC using WN devices, 16 underwent a combined
strategy: 6 TEMVR (37%), 6 typical atrial flutter ablation (37%), 2 LP
implantation (13%) and 2 atrial fibrillation ablation (13%). The WN
device was successfully implanted in 98% and 100% for single and
combined LAAC respectively (p = 0.63). Median follow-up was 13 months
(IQR 25/75 3/24) in the whole cohort. Device related complications
occurred in 6 out of 141 patients (4%) who underwent single LAAC and in
no (0/16) patient in the combined LAAC procedure (p=ns). The procedural
related complications did not differ significantly between groups (5%
vs 12%, respectively in the single and combined group, p=0.1).
Conclusion: Combined procedure combining LAAC using the Watchman™
devices and one other structural or electrophysiological procedure is
safe and effective. Larger series are needed to confirm these results.