Silent Cerebral Embolism after Left Atrial Appendage Occlusion

Abstract Background Left atrial appendage (LAA) intervention is an alternative to oral anticoagulation therapy for thromboprophylaxis in atrial fibrillation (AF). There is limited data on procedure-related silent cerebral embolisms (SCE) during LAA intervention. The aim of our study is to assess the incidence and risk factors of the new SCE after percutaneous LAA occlusion (LAAO)in AF patients and compare the rate of SCE after LAAO with LAA excision (LAAE). Methods Consecutive AF patients from 2 independent cohorts (LAAO cohort and LAAE cohort) between September 2018 and December 2020 were included. All patients underwent cerebral magnetic resonance imaging (MRI) before and within 7 days after the procedure. The incidence, size and location of SCE, as well as risk factors were analyzed. Results Forty-two patients from LAAO cohort and 32 patients from LAAE cohort were enrolled. In the LAAO cohort, patients developing SCE had significantly higher CHA2DS2-VASc scores (OR 2.172; 95% CI 1.149–4.104; p=0.017), longer LAAO placement time (OR 1.067; 95% CI 1.018–1.118; p=0.006), and lower peak activated clotting time (ACT) level (OR 0.976; 95% CI 0.954–0.998; p=0.035). Furthermore, a significantly higher incidence of new SCE was seen in LAAO cohort compared to LAAE (54.8% vs. 6.3%, p<0.001). 71.4% of SCE located in the cortex. Conclusions The incidence of procedure-related SCE was strikingly high in patients with percutaneous LAAO. More cardiovascular co-morbidities, longer LAAO placement time and lower ACT level were significantly associated with the development of SCE during LAAO procedure.