J Interv Card Electrophysiol. 2026 Aug 3. doi: 10.1007/s10840-026-02407-6. Online ahead of print.
ABSTRACT
BACKGROUND: Epicardial and endocardial left atrial appendage occlusion (LAAO) is commonly performed for stroke prevention for atrial fibrillation (AF) patients at increased risk for stroke who cannot tolerate long-term oral anticoagulation. However, there is limited data on the outcomes of unsuccessful LAAO procedures. This study aims to assess the incidence and outcomes of unsuccessful LAAO procedures.
METHODS: A retrospective analysis was performed on patients undergoing LAAO at our institution from 2020 to 2023. The primary endpoint was a failure to deploy the LAAO device, which was defined as unsuccessful device implantation (UDI).
RESULTS: A total of 411 patients underwent LAAO (Lariat = 6.8%, Amulet = 56.4%, and Watchman FLX/FLX Pro = 36.7%). UDI was observed in 4.9% (n = 20) of procedures. The cohort's mean age was 77.1 ± 10 years, and 45% were males. The mean CHA2DS2-VASc score was 4 ± 1.7, and the HASBLED score was 3.2 ± 1.4. The highest UDI rate was seen in Lariat (17.9%), followed by Watchman FLX (4.6%) and Amulet (2.2%). The primary reasons for UDI were unsatisfactory device positioning, inadequate depth attainment, anatomical incompatibility, and trabeculations impeding proper device placement. Among those with UDI, 40% underwent subsequent LAA closure using AtriClip, while the remainder continued oral anticoagulant as destination therapy. A small number had post-procedural complications.
CONCLUSION: LAAO demonstrates a low failure rate and is generally safe. LAA morphology significantly influences the procedure's success, with AtriClip surgical exclusion often serving as an option after UDI.
PMID:42545601 | DOI:10.1007/s10840-026-02407-6