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Percutaneous left atrial appendage closure in patients with primary hemostasis disorders and atrial fibrillation

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Abstract

Background or purpose

We report our single-center experience with percutaneous left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF) and primary hemostasis disorders (HD).

Methods

Consecutive patients with primary HD who underwent a percutaneous LAAC were included. Baseline characteristics, procedural data, and clinical outcomes were prospectively collected and compared with the overall LAAC cohort without HD.

Results

Since 2013, among 229 LAAC, 17 patients (7%) had a primary HD: thrombocytopenia (n = 5), myelodysplastic syndrome (n = 6), von Willebrand syndrome (n = 4), type A hemophilia (n = 1), and dysfibrinogenemia (n = 1). The HD population’s age ranged from 61 to 87 years, and the median CHA2DS2VASc was 5. Periprocedural plasmatic management was required in 47% of patients. The immediate LAAC implantation success rate was 100%. Patients received a direct oral anticoagulant (DOA) (n = 9), dual antiplatelet (n = 6), aspirin (n = 1), or no therapy (n = 1) during the first six postoperative weeks, followed with single antiplatelet (n = 16) or no therapy (n = 1) during lifelong. After 20 months, the technical success rate and procedural success rate were 100% and 94%. Zero device-/procedure-related complication and only one life-threatening bleeding occurred. Compared to patients without HD (n = 212), a baseline history of bleeding was less frequent (53% vs 91%, p < 0.001), and more patients received a perioperative blood transfusion (47% vs 4%, p < 0.001) in the HD group. The efficacy and safety outcomes did not differ between HD and non-HD cohorts.

Conclusions

Percutaneous LAAC in primary HD carriers appeared as safe and as effective as in overall LAAC population for stroke and bleeding prevention at midterm follow-up.

Graphical abstract

Percutaneous left atrial appendage closure in patients with atrial fibrillation and primary hemostasis disorders. The percutaneous LAAC in primary hemostasis disorders and AF carriers requires a multidisciplinary approach. Cardiologist, anesthesiologist, and hematologist discussion is a cornerstone to assess anticoagulant contraindication, LAAC feasibility, periprocedural management, and follow-up (high). This multidisciplinary care is illustrated by the case of a 61-year-old male with hemophilia type A and recurrent hemarthrosis. Pre-LAAC assessment confirmed procedural indication and cactus LAA anatomy (left). After plasmatic management with factor VIII infusion, a WATCHMAN™ no. 21 was successfully implanted (middle). During follow-up, without antithrombotic regime, no ischemic or hemorrhagic complication occurred (right). LAA, left atrial appendage; LAAC, left atrial appendage closure; TEE, transesophageal echocardiography. Percutaneous LAAC in primary HD carriers appeared as safe and as effective as in overall LAAC population for stroke and bleeding prevention at midterm follow-up.

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Data availability

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Abbreviations

AC:

Anticoagulant

DOA:

Direct oral anticoagulant

DRT:

Device-related thrombus

ECG:

Electrocardiogram

FA:

Atrial fibrillation

HD:

Hemostasis disorders

LAA:

Left atrial appendage

LAAC:

Left atrial appendage closure

NVAF:

Non-valvular atrial fibrillation

PASS:

Position, anchor, size, and seal

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

VKA:

Vitamin K antagonist

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Authors and Affiliations

  1. Service de Cardiologie, Institut Universitaire de Cardiologie Et de Pneumologie de Québec, 2725 Chemin de Sainte-Foy, Québec City, Québec, G1V 4G5, Canada

    Nicolas Dognin, Erwan Salaun, Catherine Champagne, Guillaume Domain, Gilles O’Hara, François Philippon, Jean-Michel Paradis, Laurent Faroux, Jonathan Beaudoin, Kim O’Connor, Mathieu Bernier, Josep Rodés-Cabau & Jean Champagne

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  1. Nicolas Dognin
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Contributions

ND, ES, CC, GD, and JC made substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data.

ND, ES, CC, GD, GO, FP, JMP, LF, JB, KO, MB, JRC, and JC drafted the work or revised it critically for important intellectual content, approved the version to be published, and agree to be accountable for all aspects of the work.

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Correspondence to Nicolas Dognin.

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Dognin, N., Salaun, E., Champagne, C. et al. Percutaneous left atrial appendage closure in patients with primary hemostasis disorders and atrial fibrillation. J Interv Card Electrophysiol 64, 497–509 (2022). https://doi.org/10.1007/s10840-021-01073-0

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