eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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3/2023
vol. 19
 
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abstract:
Original paper

Safety and efficacy of percutaneous atrial appendage closure followed by antiplatelet therapy in a high-risk population: single-center experience with a WATCHMAN device

Jakub Maksym
1
,
Agnieszka Kapłon-Cieślicka
1
,
Piotr Scisło
1
,
Zenon Huczek
1
,
Michał Marchel
1
,
Radosław Piątkowski
1
,
Janusz Kochman
1
,
Grzegorz Opolski
1
,
Marcin Grabowski
1
,
Tomasz Mazurek
1

  1. First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
Adv Interv Cardiol 2023; 19, 3 (73): 262–269
DOI: https://doi.org/10.5114/aic.2023.131480
Online publish date: 2023/09/27
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Introduction:
In our everyday practice we encounter many patients with non-valvular atrial fibrillation with either a contraindication to oral anticoagulation or with its inefficiency.

Aim:
To investigate whether left atrial appendage closure (LAAC) followed by post-procedure antiplatelet therapy is safe and efficient in a high-risk population.

Material and methods:
Ninety-one (48 males) consecutive patients with non-valvular atrial fibrillation (NVAF) underwent an LAAC procedure using a first-generation WATCHMAN 2.5 device followed by antiplatelet therapy. Clinical and transesophageal echocardiography data were collected at baseline and at the follow-up visit.

Results:
The median (IQR) CHA2DS2-VASc score was 5 (4.0–6.0) and the HAS-BLED score was 3 (3.0–4.0); the mean (SD) age was 74.4 (8.4). A bleeding history was observed in 89% of patients and 24.2% of patients had a history of stroke or transient ischemic attack (TIA). The procedure was successful in 98.9%. Post-procedure therapy was dual antiplatelet therapy in 85 patients; 3 patients received single antiplatelet therapy and the therapy was maintained until the follow-up visit. Peri-procedural complications were tamponade (3.3%), pericardial effusion (2.2%) and two deaths (2.2%) with no bleeding or vascular complications. The median follow-up was 67 (52.75–84.75) days. Primary safety endpoint (bleeding BARC type 3 or more, tamponade, pericardial effusion, and device embolization) and primary efficacy endpoint (stroke or TIA, hemorrhagic stroke, peripheral embolism, cardiovascular (CV) and non-CV death) were observed in 2 and 4 patients, respectively.

Conclusions:
The LAAC procedure followed by antiplatelet therapy seems to be safe and efficient in the high-risk population. Further studies in this field are required.

keywords:

antiplatelet therapy, atrial fibrillation, stroke prevention, left atrial appendage closure
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