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Follow-up imaging after left atrial appendage closure.

Abstract：

BACKGROUND:Because device-related thrombus (DRT) portends a poor prognosis after left atrial appendage closure with the Watchman device, surveillance transesophageal echocardiography (TEE) is recommended at 45 days and 1 year. However, oral anticoagulants are just discontinued at 45 days, rendering this early TEE unlikely to detect DRT. Indeed, DRT is most likely to occur after instituting aspirin monotherapy. OBJECTIVE:The purpose of this study was to evaluate the alternative strategy of first TEE imaging (or computed tomography) at 4 months post-Watchman implantation. METHODS:After Food and Drug Administration approval, consecutive patients undergoing Watchman implantation at 2 centers received TEE or CT at 4 months and 1 year, along with a truncated drug regimen: 6 weeks of an oral anticoagulant (or clopidogrel in a subset) plus aspirin, then 6 weeks of dual antiplatelet therapy, and finally aspirin monotherapy. RESULTS:Of the 530-patient cohort (mean age 78.7±7.9 years; 65.5% (n = 347) male; CHA2DS2-VASc score 4.5±1.4), 465 patients (87.7%) received 4-month imaging: 83.0% (440 of 530) TEE and 4.7% (25 of 530) computed tomography. Over a median follow-up of 12 months, 16 ischemic strokes (ISs), 8 transient ischemic attacks, and 1 systemic embolization occurred. Importantly, no IS occurred between 45 days and 4 months; the sole transient ischemic attack in this period (at ∼2 months) occurred 1 week after transcatheter aortic valve replacement. DRT was detected in 2.4% (11 of 465) at 4 months and 0.9% (2 of 214) at 1 year. No IS, but 1 leg embolization, was observed after DRT detection. CONCLUSION:Delaying the first imaging post-Watchman implantation to 4 months was associated with no IS between 45 days and 4 months, the "vulnerable" period of this follow-up strategy.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Kuroki K,Doshi SK,Whang W,Vanderzee S,Ducharme CB,Enomoto Y,Hanon S,Koruth JS,Miller MA,Choudry S,Sofi A,Langan N,Ellsworth B,Dukkipati SR,Reddy VY

doi

10.1016/j.hrthm.2020.06.024

subject

Has Abstract

pub_date

2020-11-01 00:00:00

pages

1848-1855

issue

11

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(20)30623-8

journal_volume

17

pub_type

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