Why Follow-up Examinations After Left Atrial Appendage Closure Are Important: Detection of Complications During Follow-u
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STRUCTURAL HEART DISEASE (RJ SIEGEL AND NC WUNDERLICH, SECTION EDITORS)
Why Follow-up Examinations After Left Atrial Appendage Closure Are Important: Detection of Complications During Follow-up and How to Deal with Them Nina C. Wunderlich 1
&
Gabriele C. Lorch 1 & Jörg Honold 1,2 & Jennifer Franke 3 & Harald Küx 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Device-related thrombus (DRT) formation and incomplete left atrial appendage closure (LAAC) are the two major complications that can occur after LAAC and can potentially limit the success of such a procedure. This review discusses the incidence, clinical and/or prognostic significance, detection methods, treatment options, and potential strategies to prevent these complications. Recent Findings It has recently been proven that the presence of a DRT represents an independent predictor for ischemic stroke after LAAC. Continued need for anticoagulation due to incomplete LAAC is clinically relevant to the patient. Summary The appearances of a DRT or an incompletely closed LAA after a LAAC procedure are not rare complications. Due to the clinical and/or prognostic significance of these complications, it is important to detect them in a timely manner during followup by using the appropriate diagnostic imaging techniques. Since a DRT is associated with an increased risk of stroke, the therapy should be aggressive. In the case of incomplete LAA closure, an additional closure device may be used to complete occlusion and avoid lifelong anticoagulation therapy. Keywords Left atrial appendage closure . Device related thrombus . Incomplete closure . Residual shunt . Device closure . Transcatheter intervention This article is part of the Topical Collection on Structural Heart Disease * Nina C. Wunderlich [email protected] Gabriele C. Lorch [email protected] Jörg Honold [email protected] Jennifer Franke [email protected] Harald Küx [email protected] 1
Cardiovascular Center Darmstadt, Dieburgerstrasse 31c, 64287 Darmstadt, Germany
2
Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany
3
Department of Cardiology, University of Heidelberg, Heidelberg, Germany
Introduction Percutaneous left atrial appendage closure (LAAC) has become an alternative to lifelong anticoagulation in patients with non-valvular atrial fibrillation (AF) and a high or prohibitive risk of bleeding [1••, 2••]. For optimal results, a closure device should cover the LAA orifice completely so that no relevant leakage occurs and no potentially thrombogenic LAA tissue comes in to contact with the systemic circulation, which can then again cause thrombus formation and thus may lead to a reduction in clinical benefit. Regardless of the device type, all studies report device-related thrombus (DRT) formation and incomplete LAA coverage as the most common complications during follow-up after LAAC. This review focuses on the incidence and clinical significance
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