Surgical And Percutaneous Left Atrial Appendage Intervention: Silent Cerebral Embolism Considerations
Kexin Wang, Zidun Wang, Weizhu Ju, Minglong Chen.
The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
BACKGROUND:Left atrial appendage intervention is an alternative to oral anticoagulation for thromboprophylaxis in atrial fibrillation. The aim of our study is to compare the incidence of silent cerebral embolisms after surgical and percutaneous intervention and to identify the risk factors of the procedure-related silent cerebral embolisms after intervention.
METHODS:This prospective observational study included consecutive atrial fibrillation patients from 2 independent cohorts (left atrial appendage excision cohort and left atrial appendage occlusion cohort) between September 2018 and December 2020. All patients underwent cerebral magnetic resonance imaging before and after the procedure. The primary endpoint was the occurrence of silent cerebral embolism after the procedure.
RESULTS:Thirty-two patients from left atrial appendage excision cohort and 42 patients from occlusion cohort were enrolled. A significantly lower incidence of silent cerebral embolism was observed in left atrial appendage excision cohort as compared with occlusion (6.3% vs. 54.8%, p<0.001). In the left atrial appendage occlusion cohort, patients who developed silent cerebral embolism after the procedure had significantly higher CHA2DS2-VASc scores (OR 2.172; 95% CI 1.149-4.104; p=0.017), longer occlusion placement time (OR 1.067; 95% CI 1.018-1.118; p=0.006), and lower peak activated clotting time level after transseptal puncture (OR 0.976; 95% CI 0.954-0.998; p=0.035).
CONCLUSIONS:The incidence of procedure-related silent cerebral embolism was strikingly lower in patients with left atrial appendage excision than in patients with occlusion. More cardiovascular co-morbidities, longer occlusion placement time and lower activated clotting time level were significantly associated with the development of procedure-related silent cerebral embolism.
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