Ten-year experience of percutaneous transcatheter left atrial appendage occlusion, procedural success and safety. Data from Latvian Centre of Cardiology during 2010–2020

Stroke is second leading cause of mortality worldwide. Cardioembolic stroke account for 20–30% of ischaemic strokes. Atrial fibrillation (AF) comprises a fivefold increased risk for ischemic stroke. Treatment with oral anticoagulation (OAC) significantly reduce stroke in patients with AF, however up to 12% of patients have contraindications for oral anticoagulant use. Left atrial appendage occlusion (LAAO) is a non-pharmacological method to prevent cardioembolic stroke in patients with AF and contraindications for long-term oral anticoagulant use. Data analysis on all LAAO procedures performed at the Latvian Centre of Cardiology (LCC) from May 2010 to October 2020 was collected using LCC registry of LAAO procedures. A total of 74 LAAO procedures were performed during years 2010-2020. Patients aged 72 ±7 years, 63% (n=46) were woman. CHA2DS2-VASc score was 5.6 ± 1.7 and HAS-BLED score 3.0 ± 1.1. A total 48% (n= 36) had a prior bleeding 42% (n=15) of wich gastrointestinal bleeding makes up 21% (n=15). Noncompliance to OAC use composed 18% (n=13) and recurrent stroke 14% (n=10). Device used for majority of cases was Amplatzer Amulet ®55% (n=41). Amplatzer ® cardiac plug used in 26% (n=19) and Watchman ® device 20% (n=15). Implant success rate was 96% (n=72, p= <0.05) Major in- hospital adverse events including stroke, death, myocardial infarction, pulmonary embolism or significant bleeding did not occur. Minor bleeding was detected in 2.8% (n=2) and vascular access complications was seen in 8% (n=6). Device embolization occurred in 4% (n=3). Our ten-year experience performing LAAO has showed high success rate, which coincides with other studies. CHA2DS2-VASc score in our study was generally higher andmajor in-hospital adverse event rate compared to other studies was lower, except device embolization rate 4% (n=3). LAAO is a safe procedure with low complication rate.