PO-104 Left atrial appendage closure with persistent thrombus

Astarcıoğlu M. A., Şen T., Kahraman F., Durmuş H. İ.

31. Ulusal Uygulamalı Girişimsel Kardiyoloji Kongresi, Antalya, Turkey, 26 - 29 April 2024, pp.83

  • Publication Type: Conference Paper / Summary Text
  • City: Antalya
  • Country: Turkey
  • Page Numbers: pp.83
  • Kütahya Health Sciences University Affiliated: Yes


Left atrial appendage (LAA) occlusion is utilized as a preventive measure against thromboembolic events in atrial fibrillation (AF) patients unable to undergo oral anticoagulation (OAC) due to contraindications or a high bleeding risk. Conventionally, the presence of LAA thrombus was considered a contraindication for LAA occlusion, although data in this regard are scarce. However, recent suggestions propose LAA occlusion as a viable option for cases of resistant thrombus formation despite OAC therapy.

We report three female patients with permanent atrial fibrillation and CHA2DS2-VASc score ≥3. Recurrent cerebral emboli occurred despite OAC. The OAC was switched to warfarin, and aspirin was added. Transesophageal echocardiography (TEE) revealed a thrombus in the LAA, which persisted despite the change in OAC and the addition of aspirin. 

TEE performed on the day of the procedure revealed thrombus formation in the LAA, along with sludge and spontaneous echo contrast (Video 1). The transseptal puncture was performed, and the guidewire was positioned in the left superior pulmonary vein. Subsequently, the transseptal sheath was exchanged for a double-curved dedicated sheath (Amplatzer TorqVue 45x45, 14 F, AGA Medical). The size of the LAA was calibrated using TEE in several views, and an Amulet Device (Fa. AGA Medical) was chosen for all patients. The placement of the device at the landing zone was performed using the so-called fish ball technique (Video 2). After confirming optimal positioning, the device was delivered. No further repositioning maneuvers were made. Finally, the position of the Amulet device was confirmed via fluoroscopy and TEE. The device exhibited complete occlusion of the LAA without any leakage (Video 3, 4). No stroke or TIA occurred, and the patients were discharged the next day. 

We conclude that LAA occlusion may present an options in selected patients with LAA thrombus, in particular when using the fish ball technique.