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- Title
Surgical and percutaneous left atrial appendage intervention: silent cerebral embolism considerations.
- Authors
Wang, Zidun; Wang, Kexin; Lu, Shanshan; Zhang, Lian; Li, Mingfang; Ju, Weizhu; Ni, Buqing; Gu, Weidong; Shao, Yongfeng; Chen, Minglong
- Abstract
Open in new tab Download slide OBJECTIVES Left atrial appendage intervention is an alternative to oral anticoagulation for thromboprophylaxis in atrial fibrillation. The aim of our study was to compare the incidence of silent cerebral embolisms after surgical and percutaneous intervention and to identify the risk factors for 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 (LAAE) 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. Silent cerebral embolism was defined as new focal hyperintense lesions detected only on postprocedural sequence. RESULTS Thirty-two patients from the LAAE cohort and 42 patients from the occlusion cohort were enrolled. A significantly lower incidence of silent cerebral embolism was observed in the LAAE 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 [odds ratio (OR) 2.172; 95% confidence interval (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 LAAE than in patients with occlusion. More cardiovascular comorbidities, longer occlusion placement time and lower activated clotting time level were significantly associated with the development of procedure-related silent cerebral embolism.
- Subjects
LEFT heart atrium; EMBOLISMS; ATRIAL fibrillation; MAGNETIC resonance imaging
- Publication
European Journal of Cardio-Thoracic Surgery, 2023, Vol 63, Issue 6, p1
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezad074