First Experience of Transcatheter Leak Occlusion With Detachable Coils Following Left Atrial Appendage Closure

Domenico G Della Rocca; Rodney P Horton; Luigi Di Biase; Mohamed Bassiouny; Amin Al-Ahmad; Sanghamitra Mohanty; Alessio Gasperetti; Veronica N Natale; Chintan Trivedi; Carola Gianni; J David Burkhardt; G Joseph Gallinghouse; Patrick Hranitzky; Javier E Sanchez; Andrea Natale

doi:10.1016/j.jcin.2019.10.022

First Experience of Transcatheter Leak Occlusion With Detachable Coils Following Left Atrial Appendage Closure

JACC Cardiovasc Interv. 2020 Feb 10;13(3):306-319. doi: 10.1016/j.jcin.2019.10.022. Epub 2020 Jan 15.

Authors

Affiliations

¹ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas. Electronic address: domenicodellarocca@hotmail.it.
² Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
³ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
⁴ Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
⁵ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Interventional Electrophysiology, Scripps Clinic, La Jolla, California; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Cardiology, Stanford University, Stanford, California; Dell Medical School, University of Texas, Austin, Texas.

PMID: 31954677
DOI: 10.1016/j.jcin.2019.10.022

Abstract

Objectives: The aim of this study was to assess 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 min 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).

Keywords: atrial fibrillation; coil; leak; left atrial appendage; stroke.

MeSH terms

Aged
Aged, 80 and over
Atrial Appendage* / diagnostic imaging
Atrial Appendage* / physiopathology
Atrial Fibrillation / complications
Atrial Fibrillation / diagnostic imaging
Atrial Fibrillation / physiopathology
Atrial Fibrillation / therapy*
Cardiac Catheterization / adverse effects
Cardiac Catheterization / instrumentation*
Echocardiography, Doppler, Color
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Embolization, Therapeutic / adverse effects
Embolization, Therapeutic / instrumentation*
Equipment Design
Feasibility Studies
Female
Humans
Male
Middle Aged
Risk Factors
Thromboembolism / diagnosis
Thromboembolism / etiology
Thromboembolism / prevention & control*
Time Factors
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT03503253