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Feasibility and efficacy of percutaneous left atrial appendage occlusion in hypertrophic cardiomyopathy patients with atrial fibrillation
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  • XIAOCHUN ZHANG,
  • QINCHUN JIN,
  • SHASHA CHEN,
  • DANDAN CHEN,
  • DAHONG KONG,
  • LEI ZHANG,
  • MINGFEI LI,
  • DAXIN ZHOU,
  • JUN-BO GE
XIAOCHUN ZHANG
Zhongshan Hospital Fudan University
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QINCHUN JIN
Zhongshan Hospital Fudan University
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SHASHA CHEN
Zhongshan Hospital Fudan University
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DANDAN CHEN
Zhongshan Hospital Fudan University
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DAHONG KONG
Zhongshan Hospital Fudan University
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LEI ZHANG
Shanghai Institute of Cardiovascular Diseases
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MINGFEI LI
Zhongshan Hospital Fudan University
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DAXIN ZHOU
Zhongshan Hospital Fudan University
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JUN-BO GE
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Shanghai Medical College of Fudan University
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Abstract

Background: Prophylactic anticoagulation was recommended for stroke prevention in patients with hypertrophic cardiomyopathy(HCM) and atrial fibrillation(AF) regardless of CHA2DS2-VASC score but the strategy was in a dilemma for patients with contraindication to antigulants. Aims: To estimate the safety and efficacy of left atrial appendage occlusion(LAAO) in HCM patients with atrial fibrillation(AF). Methods and results: This prospective study included 25 HCM patients(age 70.04±11.62years, 72% male, 16/25(64.00%) had prior stroke) with AF eligible for LAAO. Clinical outcomes and echocardiographic parameters were collected and assessed during procedure and follow-up(3, 6, and 12months post-procedure). The composite safety outcomes included all-cause death, major bleeding and procedure-related complications. The primary efficacy outcome was defined as ischemic stroke and systemic embolization. Successful implantation was achieved in 24 patients(96%) using Watchman device without severe peri-device leaks (PDL), while one patient developed new-onset thrombus before access puncture on the operative day. Median follow-up was 1.5 years with a total of 38.1 patient-years. Only one patient experienced non-disabling ischemic stroke. The occurrence of major bleeding was 1/24(4.17%), with a remarkable reduction in annual 3 bleeding risk by 56.18% compared to the predicted rate. Device-related thrombus(DRT) was detected in 3/24(12.50%) patients. Neither serious procedure-related complications nor death events were reported in our study. Conclusion: Our study suggested the feasibility and safety of LAAO in HCM patients for stroke prevention. Whereas, thrombus formation remains a concern depending on hemodynamic abnormality associated with HCM. Further follow-up visits on larger sample size would facilitate the evaluation of LAAO in this high-risk cohort.

Peer review status:IN REVISION

31 May 2020Submitted to Journal of Cardiovascular Electrophysiology
04 Jun 2020Assigned to Editor
04 Jun 2020Submission Checks Completed
04 Jun 2020Reviewer(s) Assigned
01 Jul 2020Review(s) Completed, Editorial Evaluation Pending
02 Jul 2020Editorial Decision: Revise Minor
27 Aug 20201st Revision Received