Does Spontaneous Echo Contrast in the Left Atrial Appendage Increase Thromboembolism Risk After Left Atrial Appendage Closure? A Retrospective Study on Its Impact on Device-Related Thrombosis and Arterial Thromboembolic Events

Abstract

Background: Left atrial appendage closure (LAAC) prevents arterial thromboembolic events (ATEs) in nonvalvular atrial fibrillation (AF). Spontaneous echo contrast (SEC) is an independent risk factor for left atrial appendage (LAA) thrombosis; however, there is little knowledge about the relationship between preoperative SEC and the increased risk of device-related thrombosis (DRT) or ATEs in patients with AF who have undergone LAAC.

Methods: This retrospective study focused on patients with nonvalvular AF who successfully underwent LAAC surgery. Transesophageal echocardiography (TEE) was used to assess preoperative LAA status. SEC in LAA Grades 0–2 was defined as LAASEC−, and Grades 3–4 or previously diagnosed LAA thrombus formation as LAASEC+.

Results: A total of 519 AF patients (432 in LAASEC− group and 87 in LAASEC+ group) who underwent LAAC were included. At the 1-year follow-up, there was no significant difference in the incidence of DRT (2.5 vs. 3.8%, p = 0.636), ATEs (0.5 vs. 0%, p = 0.525), and all-cause mortality (2.1% vs. 2.3%, p = 0.899) between the LAASEC− group and the LAASEC+ group. However, the LAASEC+ group had higher proportions of cauliflower-type LAA and ≥ 3 lobes.

Conclusions: The difference in preoperative LAA thrombosis or LAASEC was not related to the incidence of DRT or ATEs in AF patients within 1 year after LAAC.