Department of Cardiovascular Medicine, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Heart Rhythm. 2021 May;18(5):717-722. doi: 10.1016/j.hrthm.2021.01.030. Epub 2021 Feb 4.
Left atrial appendage closure (LAAC) has proven to be an effective alternative to long-term oral anticoagulation in the prevention of thromboembolic events in patients with atrial fibrillation. In a minority of patients, inadequate seal may result in persistent peridevice flow and inability of the appendage to fully thrombose, thereby representing a potential source for thromboembolism.
The purpose of this study was to study the use of endovascular coiling of the appendage to address persistent peridevice leak in patients undergoing LAAC with the Watchman device.
This is a retrospective single-center analysis involving patients who underwent placement of a LAAC device and returned for endovascular coiling to address persistent device leak between 2018 and 2020. Baseline characteristics, procedural outcomes, and follow-up echocardiograms were analyzed to demonstrate the feasibility and safety of this technique.
Patients (N = 20) were identified with a mean leak size of 3.8 ± 1.3 mm (range 2.5-7 mm), all of whom had a non-thrombosed appendage. Acute procedural success was achieved in 95% of patients. Complete or significant reduction in flow beyond the LAAC device was achieved in 61% and 33% of patients, respectively. The 1 procedure-related adverse event was a pericardial effusion before coil deployment, requiring percutaneous drainage.
The clinical impact of residual peridevice leak post-Watchman implantation is a matter of continuing investigation. However, appendage coiling represents a new therapeutic tool to address this potential source for thromboembolism. Further studies should address the clinical impact of this technique, including the safety of discontinuing anticoagulation after successful coiling.
左心耳封堵术（LAAC）已被证明可有效替代长期口服抗凝治疗，预防房颤患者的血栓栓塞事件。在少数患者中，封堵不完全可能导致持续性设备周围漏流和心耳无法完全血栓形成，从而成为血栓栓塞的潜在来源。
本研究旨在研究使用血管内线圈封闭心耳，以解决接受 Watchman 装置 LAAC 的患者中持续性设备周围漏的问题。
这是一项回顾性单中心分析，涉及 2018 年至 2020 年间接受 LAAC 设备植入并因持续性设备漏而返回行血管内线圈封闭的患者。分析了基线特征、手术结果和随访超声心动图，以证明该技术的可行性和安全性。
共确定 20 例患者，平均漏口大小为 3.8 ± 1.3mm（范围 2.5-7mm），所有患者的心耳均未发生血栓形成。95%的患者获得了急性手术成功。LAAC 装置外的血流完全或显著减少分别在 61%和 33%的患者中实现。唯一的 1 例手术相关不良事件是线圈置入前心包积液，需要经皮引流。
Watchman 植入后残余设备周围漏的临床影响仍在继续研究中。然而，心耳线圈封闭术代表了一种新的治疗工具，可以解决这种潜在的血栓栓塞来源。进一步的研究应解决该技术的临床影响，包括在成功线圈封闭后停止抗凝的安全性。
