Abstract 281 Symptomatic vs. non-symptomatic device-related thrombus after LAAC– a sub-analysis from the multicenter EUROC-DRT registry

BACKGROUND

Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is a common complication and is associated with adverse outcome, i.e. ischemic stroke or systemic embolism (SE). However, data on predictors of stroke/SE in the context of DRT are limited.

AIMS

This study aimed to identify predisposing factors for stroke/SE in patients that develop DRT after LAAC. Also, temporal connection of stroke/SE to DRT diagnosis was analyzed.

METHODS

The multicenter EUROC-DRT registry included 176 patients, in whom DRT after LAAC were diagnosed. Patients with symptomatic DRT, defined as stroke/SE in the context of DRT diagnosis, were compared against patients with non-symptomatic DRT. Baseline characteristics, anti-thrombotic regimens, device position, and timing of stroke/SE were compared.

RESULTS

Stroke/SE occurred in 25/176 (14.2%) patients diagnosed with DRT (symptomatic DRT). Stroke/SE occurred after a median of 198 days (IQR: 37-558) after LAAC. In 45.8% stroke/SE occurred within one month before/after DRT diagnosis (DRT-related stroke). Patients with symptomatic DRT had lower left ventricular ejection fractions (50.0±9.1% vs. 54.2±11.0%, p=0.03) and higher rates of non-paroxysmal atrial fibrillation (84.0% vs. 64.9%, p=0.06). Other baseline parameters and device position were not different. Most ischemic events occurred among patients with single antiplatelet therapy (50%), however, stroke/SE was also observed under dual antiplatelet therapy (25%) or oral anticoagulation (20%).

CONCLUSION

Stroke/SE are documented in 14.2% and occur both in close temporal relation to the DRT finding and chronologically independently therefrom. Evidence of risk factors remains scarce, putting all DRT patients at substantial risk for stroke/SE. Further studies are necessary to minimize the risk of DRT and ischemic events.

Figure 1) Timing of stroke/SE from DRT diagnosis in each reported case of symptomatic DRT

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Symptomatic vs. non-symptomatic device-related thrombus after LAAC– a sub-analysis from the multicenter EUROC-DRT registry
V. O. Vij¹, I. Cruz-Gonzalez², R. Galea³, K. D. Piayda⁴, D. Nelles¹, L. Vogt¹, S. Gloekler⁵, M. Fürholz³, B. Meier³, L. Räber³, G. O'Hara⁶, D. Arzamendi⁷, V. Agudelo⁷, L. Asmarats⁷, X. Freixa⁸, E. Flores-Umanzor⁸, O. De Backer⁹, L. Sondergaard⁹, L. Nombela-Franco¹⁰, A. McInerney¹⁰, K. Korsholm¹¹, J. E. Nielsen-Kudsk¹¹, S. S. Afzal¹², T. Zeus¹², F. K. Operhalski¹³, B. Schmidt¹⁴, G. Montalescot¹⁵, P. Guedeney¹⁵, X. Iriart¹⁶, N. Miton¹⁶, J. Saw¹⁷, T. Gilhofer¹⁸, L. Fauchier¹⁹, E. Veliqi²⁰, F. Meincke²¹, N. Petri²², P. Nordbeck²³, R. Gonzalez-Ferreiro², D. L. Bhatt²⁴, A. Laricchia²⁵, A. Mangieri²⁵, H. Omran²⁶, J. W. Schrickel¹, J. Rodes-Cabau⁶, G. Nickenig¹, H. Sievert⁴, A. Sedaghat¹
¹Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn; ²2) University Hospital of Salamanca, CIBER CV, Salamanca, ES; ³Klinik und Poliklinik für Kardiologie, Inselspital - Universitätsspital Bern, Bern, CH; ⁴CVC Rhein-Main GmbH, Frankfurt am Main; ⁵Zentrum Innere Medizin · Medizinische Klinik I, Klinikum Hochrhein GmbH, Waldshut; ⁶Quebec Heart & Lung Institute, Laval University, Quebec, CA; ⁷Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, ES; ⁸Cardiology, Hospital Clinic Barcelona, Barcelona, ES; ⁹Cardiology, Rigshospitalet Copenhagen, Copenhagen, DK; ¹⁰Cardiology, Hospital Clinico San Carlos Madrid, Madrid, ES; ¹¹Cardiology, Aarhus University Hospital, Aarhus, DK; ¹²Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf; ¹³Medizinische Klinik I, Main-Kinzig-Kliniken GgmbH, Gelnhausen; ¹⁴Agaplesion Markus Krankenhaus, Frankfurt am Main; ¹⁵Cardiology, Pitié-Salpêtrière Hospital, Paris, FR; ¹⁶Cardiology, University Hospital Bordeaux, Paris, FR; ¹⁷Vancouver General Hospital, Vancouver, CA; ¹⁸Kardiologie, Stadtspital Triemli Zürich, Zürich, CH; ¹⁹Cardiology, University Hospital Tours, Tours, FR; ²⁰Kardiologie, Asklepios Klinik St. Georg, Hamburg; ²¹3. Med. Abteilung - Kardiologie, Pneumologie und Internistische Intensivmedizin, Asklepios Klinik Altona, Hamburg; ²²Medizinische Klinik und Poliklinik I, ZIM Kardiologie, Universitätsklinikum Würzburg, Würzburg; ²³Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg; ²⁴Cardiology, Brigham and Women’s Hospital Heart and Vascular Center, Boston, US; ²⁵Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy and Humanitas Research Hospital IRCCS, Rozzano, IT; ²⁶Innere Medizin / Kardiologie, GFO Kliniken Bonn, Bonn;
BACKGROUND Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is a common complication and is associated with adverse outcome, i.e. ischemic stroke or systemic embolism (SE). However, data on predictors of stroke/SE in the context of DRT are limited. AIMS This study aimed to identify predisposing factors for stroke/SE in patients that develop DRT after LAAC. Also, temporal connection of stroke/SE to DRT diagnosis was analyzed. METHODS The multicenter EUROC-DRT registry included 176 patients, in whom DRT after LAAC were diagnosed. Patients with symptomatic DRT, defined as stroke/SE in the context of DRT diagnosis, were compared against patients with non-symptomatic DRT. Baseline characteristics, anti-thrombotic regimens, device position, and timing of stroke/SE were compared. RESULTS Stroke/SE occurred in 25/176 (14.2%) patients diagnosed with DRT (symptomatic DRT). Stroke/SE occurred after a median of 198 days (IQR: 37-558) after LAAC. In 45.8% stroke/SE occurred within one month before/after DRT diagnosis (DRT-related stroke). Patients with symptomatic DRT had lower left ventricular ejection fractions (50.0±9.1% vs. 54.2±11.0%, p=0.03) and higher rates of non-paroxysmal atrial fibrillation (84.0% vs. 64.9%, p=0.06). Other baseline parameters and device position were not different. Most ischemic events occurred among patients with single antiplatelet therapy (50%), however, stroke/SE was also observed under dual antiplatelet therapy (25%) or oral anticoagulation (20%). CONCLUSION Stroke/SE are documented in 14.2% and occur both in close temporal relation to the DRT finding and chronologically independently therefrom. Evidence of risk factors remains scarce, putting all DRT patients at substantial risk for stroke/SE. Further studies are necessary to minimize the risk of DRT and ischemic events. Figure 1) Timing of stroke/SE from DRT diagnosis in each reported case of symptomatic DRT
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