Abstract 19579: The Incidence of Stroke and Pericardial Effusion after Pericardial Suture Ligation of the Left Atrial Appendage
Introduction: Left atrial appendage closure (LAAC) is an effective alternative to warfarin in nonvalvular AF patients who are intolerant to oral anticoagulation. Our aim was to determine the incidence of stroke and pericardial effusion following pericardial suture ligation of the left atrial appendage.
Methods: Retropspective analysis of 16 patients who underwent LAAC with an epicardial suture delivery system (LARIAT) at single center. Pericardial access was obtained using an anterior approach, followed by transeptal puncture. Epicardial and endovascular magnetic-tipped guidewires were then aligned, and the epicardial snare and suture were advanced over the left atrial appendage. After snare closure and suture deployment, TEE and fluoroscopy were used to confirm left atrial appendage exclusion. Patients were discharged on aspirin. Reported stroke or TIA events were confirmed by CT or MRI.
Results: Of the 16 patients included, the mean age was 74.2 ±9.1, 56% of patients (9/16) were male, and the mean CHADS2 score was 3.6 ± 1.2; 11 patients (69%) had a prior stroke or TIA. These patients accumulated a total of 9.6 person-years of follow up (5.3 months ±7.7). LAAC was confirmed by repeat TEE at 1.95 ± 3.0 months, and 7/16 patients (44%, 95% CI 10-77%) experienced any size left atrial appendage leak, and 1/16 (6%, 95% CI 0-20%) experienced a large leak (≥3mm). After LAAC, 1/16 patients experienced a stroke. A 71 year old male (CHADS2 = 3) who was not on anticoagulation developed a central retinal artery occlusion 5 months post-procedure. The overall incidence of stroke or TIA was 6%, (95% CI 0-20%). After LAAC, 3/16 patients developed a pericardial effusion (19%, 95% CI 0-40%), of which 2 required pericardiocentesis.
Conclusion: We observed a significant rate of pericardial effusion and symptomatic ischemic events after LAAC with an epicardial suture ligation system; further study is needed to assess its relative safety compared to alternate LAAC devices in patients intolerant to oral anticoagulation.
- © 2012 by American Heart Association, Inc.