https://doi.org/10.1007/s00392-025-02625-4
1RHÖN-KLINIKUM AG Campus Bad Neustadt Klinik für Kardiologie II / Interventionelle Elektrophysiologie Bad Neustadt a. d. Saale, Deutschland; 2Universitäts-Herzzentrum Freiburg / Bad Krozingen Klinik für Kardiologie und Angiologie Bad Krozingen, Deutschland; 3Klinikum Nürnberg Süd Kardiologie Nürnberg, Deutschland
Introduction:
Left atrial appendage (LAA) occlusion is a well established approach for patients with atrial fibrillation and contraindication for oral anticoagulation. Most common is the endocardial closure technique with implanting an endovascular plug device. Epicardial ligation is not as widely spread despite the advantage of omitting any anticoagulation straight after ligation. At our center we perform both procedures and present a retrospective comparison between both techniques.
Method:
During December 2018 until August 2024 112 patients were treated with LAA occlusion, 75 with epicardial approach using Lariat (epigroup), 42 patients with contraindication for epicardial ligation with the endocardial Amulet plug device (endogroup). 1 patient was treated with a hybrid approach endo- and epicardial. In 1 patient neither epicardial (pericardial adhesions) nor endocardial LAA (air aspiration) occlusion was successful.
Results:
69 patients were treated with epicardial ligation, 42 patients with implantation of an endocardial plug. Mean age (76,7 y), mean CHADSVASC score (4), mean HASBLED score (3,3), coronary heart disease (46 %), ejection fraction (54 %) and diabetes were evenly distributed in both groups.
Procedure time (mean 83 min vs 62 min) and fluoroscopy time (17, min vs 6,16 min) were significant higher in the epicardial ligation group. Silent cerebral lesions (SLE) in MRI were higher in the epicardial group (13,0 % vs 8 %). Procedure related major complication occurred in 1 patient in the epigroup, no in the endogroup. 3 months FUP revealed 5 thrombi in the epicardial group and 0 in the endogroup (8 % vs 0 %), but 1 central gap (2 mm) in the epigroup and 6 peridevice leakage (PDL) of 2 - 8 mm in the endogroup (1,4 % vs 16 %). We observed 2 deaths in the first 6 weeks, 1 fatal cerebral bleeding under DAPT in the endo group and 1 fatal stroke in the epigroup. 12 months FUP revealed no thrombus in both groups, but still 6 PDLs in the endogroup.
Conclusion:
Epicardial ligation of LAA is associated with more fluoroscopy time, more procedure time and more SCL than implantation a plug device. Early FUP revealed more thrombi in the epigroup, but more PDLs in the endogroup. 1 year-FUP showed resolution of all thrombi, but still presence of all PDLs.