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B-PO03-152
LEFTATRIAL APPENDAGE OCCLUSION IN PATIENTS WITH
INTRACRANIAL HEMORRHAGE
Jalaj Garg MD, Siddharth Shah MBBS, Kuldeep Bharat Shah MD,
Mohit K. Turagam MD, FHRS, Andrea Natale MD, FHRS and
Dhanunjaya R. Lakkireddy MD, FHRS
Background: Patients with prior intracranial hemorrhage (ICH)
and atrial fibrillation (AF) are at increased risk of recurrent
bleeding; and often not treated with oral anticoagulation despite
high risk of ischemic stroke.
Objective: To assess safety and efficacy of percutaneous left
atrial appendage occlusion (LAAO) in patients with AF and ICH.
Methods: The meta-analysis was performed using a meta-
package for R version 4.0/RStudio version 1.2 and Freeman
Tukey double arcsine method to establish the variance of raw
proportions. The outcomes studied were - (1) acute procedure
success; (2) periprocedural complications (within 7 days); (3)
post procedure complication (.7 days); (4) all-cause mortality.
Results: Seven retrospective studies, including 407 ICH patients
who underwent LAAO met study inclusion criteria (mean age
74.266.8 years, and 35.6% females). Mean CHA
2
DS
2
VASC and
HAS-BLED scores were 4.8 61.5 and 4 61, respectively. Time
to LAAO from ICH was 452.3 6652.3 days. Only 26.3% patients
received oral anticoagulants post LAAO while rest received
single or dual antiplatelet therapy. Acute procedure success was
achieved in 98.5% patients. Periprocedural complications
included - major bleeding 0.7%, pericardial effusion 0.7%, device
embolization 0.7%, device related thrombosis (DRT) 0.5% and
recurrent ICH 0.2%. Complications observed during the follow up
period (14.6610.1 months) included - major bleeding 0.9%,
recurrent ICH 0.5%, ischemic stroke 1.5%, DRT 1.2%, device
embolization 0.2%, and all-cause mortality 2.4%.
Conclusion: LAAO is a safe and effective therapeutic option in
patients with AF and prior history of ICH with an acceptable
periprocedural and post procedure risk.
B-PO03-153
LEFT ATRIAL APPENDAGE OCCLUSION IN PATIENTS WITH
PERSISTENT THROMBUS: A CASE SERIES
Sandeep K. Goyal MD, FHRS
Background: Percutaneous left atrial appendage (LAA) closure
is contraindicated in patients with persistent LAA thrombus. This
leaves a small number of patients at very high risk of future
stroke. There are no established alternatives to treat these
patients.
Objective: Evaluate novel approaches to perform LAA closure in
patients with persistent LAA thrombus.
Methods: A retrospective review of
WatchmanÔimplants performed at our institution to
identify patients who were implanted with persistent LAA
thrombus.
Results: Three patients underwent implantation of the
Watchman device despite persistent LAA thrombus. The first
patient had a Watchman 2.5 device and the other two
underwent a Watchman flex device implant. All implants were
performed with concurrent use of the Sentinel cerebral
protection system (CPS). There were no periprocedural
cerebrovascular events and all three patients were implanted
successfully. Follow-up imaging at a 6-week interval showed a
well-seated device and no evidence of device related
thrombus or peri-device leaks.
Conclusion: In patients with persistent LAA thrombus,
implantation of the Watchman device appears to be safe and
effective when performed with concurrent use of Sentinel
cerebral protection system (CPS). A larger retrospective registry
and further prospective data are needed to confirm these
findings.
B-PO03-154
METABOLIC EFFECTS OF THE LEFT ATRIAL APPENDAGE
EXCLUSION (THE HEART HORMONE STUDY)
Randall J. Lee MD, PhD, Krzysztof Bartus and
Dhanunjaya R. Lakkireddy MD, FHRS
Background: It is currently unknown whether the elimination of
ANP and other neurohormone secretion from LAA in AF patients
can have any consequences on long term physiological
regulation of lipid and glucose metabolism, obesity, and insulin
resistance.
Objective: To investigate the lipid and glucose metabolism and
acting on the metabolism of broader hormones and long-term
follow-up covering 2 years in patients who undergone epicardial
LAA closure procedure.
Methods: In a single-center prospective observational study,
60 patients with longstanding persistent AF with
cardiovascular risk factors had undergone an epicardial
exclusion procedure. Anthropometric parameters and
glucose, glycated hemoglobin (HbA1c), insulin, leptin,
adiponectin, free fatty acids, beta-hydroxybutyrate, and total
cholesterol levels were evaluated on fasting at baseline
before the procedure and compared with levels at 24 hours, 7
days, 1 month, 3 months, 6 months, and 24 months after the
procedure.
Results: Device implantation (LARIAT) was successful in all
60 patients. No complications were noted. Postprocedural
transesophageal echocardiogram (TEE) showed complete
LAA closure in all patients, no leak was observed. The group
Poster Session III S251
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