An updated meta-analysis of device related thrombus following left atrial appendage closure in patients with atrial fibrillation

Clinical and subclinical acute brain injury caused by invasive cardiovascular procedures

Over the past 50 years, the number and invasiveness of percutaneous cardiovascular procedures globally have increased substantially. However, cardiovascular interventions are inherently associated with a risk of acute brain injury, both periprocedurally and postprocedurally, which impairs medical outcomes and increases health-care costs. Current international clinical guidelines generally do not cover the area of acute brain injury related to cardiovascular invasive procedures. In this international Consensus Statement, we compile the available knowledge (including data on prevalence, pathophysiology, risk factors, clinical presentation and management) to formulate consensus recommendations on the prevention, diagnosis and treatment of acute brain injury caused by cardiovascular interventions. We also identify knowledge gaps and possible future directions in clinical research into acute brain injury related to cardiovascular interventions.

Position Statement on Cardiac Computed Tomography Following Left Atrial Appendage Occlusion

Left atrial appendage occlusion (LAAO) is rapidly growing as valid stroke prevention therapy in atrial fibrillation. Cardiac imaging plays an instrumental role in preprocedural planning, procedural execution, and postprocedural follow-up. Recently, cardiac computed tomography (CCT) has made significant advancements, resulting in increasing use both preprocedurally and in outpatient follow-up. It provides a noninvasive, high-resolution alternative to the current standard, transesophageal echocardiography, and may display advantages in both the detection and characterization of device-specific complications, such as peridevice leak and device-related thrombosis. The implementation of CCT in the follow-up after LAAO has identified new findings such as hypoattenuated thickening on the atrial device surface and left atrial appendage contrast patency, which are not readily assessable on transesophageal echocardiography. Currently, there is a lack of standardization for acquisition and interpretation of images and consensus on definitions of essential findings on CCT in the postprocedural phase. This paper intends to provide a practical and standardized approach to both acquisition and interpretation of CCT after LAAO based on a comprehensive review of the literature and expert consensus among European and North American interventional and imaging specialists.

Left Atrial Appendage Occlusion and Post-procedural Antithrombotic Management

Left atrial appendage occlusion (LAAO) is an established alternative to oral anticoagulation for stroke prevention in atrial fibrillation. Antithrombotic therapy is used in the post-procedural period to prevent device-related thrombosis (DRT). The risk of DRT is considered highest in the first 45-90 days after device implantation, based on animal studies of the device healing process. Clinically applied antithrombotic regimens vary greatly across studies, continents, and centers. This article gives an overview of the evidence behind current antithrombotic regimens, ongoing randomized trials, and future post-procedural management.

Challenges and Insights in Managing Device-Related Thrombosis Post-WATCHMAN Implantation: A Case Report of Surgical Thrombectomy in an Elderly Jehovah's Witness Patient With Atrial Fibrillation

The WATCHMAN device offers a viable alternative to long-term oral anticoagulation for stroke prevention in nonvalvular atrial fibrillation, particularly for high-risk patients. Despite its success, device-related thrombosis (DRT) remains a concern, potentially restricting its wider use. We present an 83-year-old female Jehovah's Witness with atrial fibrillation who, after successful WATCHMAN device implantation, suffered multiple transient ischemic attacks six months later. Initial investigation revealed a thrombus on a slightly exposed strut of the almost completely endothelialized device. Despite treatment with warfarin and rivaroxaban, urgent surgical intervention was ultimately required to remove the thrombus completely. This case illustrates the risk of thrombus formation even with minimal strut exposure and the challenges in managing DRT. It also highlights the necessity for diligent monitoring and potential reassessment of post-implantation anticoagulation protocols. Our report adds to the limited literature regarding surgical thrombectomy following WATCHMAN implantation and provides valuable insights for clinicians managing similar scenarios.