Author + information
- Received May 28, 2019
- Revision received October 7, 2019
- Accepted October 8, 2019
- Published online January 15, 2020.
- Domenico G. Della Rocca, MDa,∗ (, )
- Rodney P. Horton, MDa,
- Luigi Di Biase, MD, PhDa,b,c,
- Mohamed Bassiouny, MDa,
- Amin Al-Ahmad, MDa,
- Sanghamitra Mohanty, MDa,
- Alessio Gasperetti, MDa,
- Veronica N. Natale, BSd,
- Chintan Trivedi, MD, MPHa,
- Carola Gianni, MD, PhDa,
- J. David Burkhardt, MDa,
- G. Joseph Gallinghouse, MDa,
- Patrick Hranitzky, MDa,
- Javier E. Sanchez, MDa and
- Andrea Natale, MDa,e,f,g,h
- aTexas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas
- bArrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- cDepartment of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
- dBloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- eInterventional Electrophysiology, Scripps Clinic, La Jolla, California
- fDepartment of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- gDivision of Cardiology, Stanford University, Stanford, California
- hDell Medical School, University of Texas, Austin, Texas
- ↵∗Address for correspondence:
Dr. Domenico G. Della Rocca, Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, 3000 North I-35, Suite 720, Austin, Texas 78705.
Objectives The aim of this study was to asses the feasibility and efficacy of transcatheter leak closure with detachable coils in patients with incomplete left atrial appendage (LAA) closure.
Background Incomplete LAA closure is common after interventional therapies targeting the LAA, potentially hindering effective thromboembolic prevention. Detachable coils have found a wide range of applications for transcatheter vascular occlusion and embolization procedures.
Methods Thirty consecutive patients at high thromboembolic risk with clinically relevant residual leaks (mean age 72 ± 9 years, 73.3% men, mean CHA2DS2-VASc score 4.4 ± 1.4, mean HAS-BLED score 3.6 ± 0.8) underwent percutaneous closure of the LAA patency using embolization coils. Transesophageal echocardiography was performed at 60 ± 15 days post-procedure.
Results LAA closure had been previously attempted with the Watchman device in 25 patients, the Amulet device in 2 patients, and the LARIAT device in 3 patients. Baseline transesophageal echocardiography documented moderate and severe leaks in 20 (66.7%) and 10 (33.3%) patients, respectively. After a single procedure, 25 patients (83.3%) showed complete LAA sealing or minimal leaks. Five patients (16.7%) had moderate residual leaks; 3 patients of them were offered repeat procedures. Mean procedure and fluoroscopy times were 76 ± 41 and 21 ± 14 min, respectively; the mean volume of iodinated contrast medium used was 80 ± 47 ml. Coil deployment was successful in all cases. The overall complication rate was 6.1%. After a median follow-up period of 54 days (range: 43 to 265 days) and an average of 1.1 procedures/patient, transesophageal echocardiography revealed complete LAA sealing or negligible residual leaks in 28 patients (93.3%; 25 with no residual leak, 3 patients with minimal to mild residual leaks) and moderate residual leaks in 2 patients (6.7%).
Conclusions Transcatheter LAA leak occlusion using endovascular coils appears to be a safe, effective, and promising approach in patients at high echo time risk with incomplete LAA closure. (Transcatheter Leak Closure With Detachable Coils Following Incomplete Left Atrial Appendage Closure Procedures [TREASURE]; NCT03503253)
Dr. Burkhardt is a consultant for Biosense Webster and Stereotaxis. Dr. Di Biase is a consultant for Biosense Webster, Boston Scientific, Stereotaxis, and St. Jude Medical; and has received speaking honoraria from Medtronic, Atricure, EPiEP, and Biotronik. Dr. Natale has received speaking honoraria from Boston Scientific, Biosense Webster, St. Jude Medical, Biotronik, and Medtronic; and is a consultant for Biosense Webster, St. Jude Medical, and Janssen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 28, 2019.
- Revision received October 7, 2019.
- Accepted October 8, 2019.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.