Results
The combined procedure cohort comprised 54.7% male, with a median age
of 67 years. Half of the cohort was diagnosed with persistent AF.
Relatively high risks of stroke (median CHA2DS2-VASc score=3) and
bleeding (median HAS-BLED score=2) can be observed (Table 1 ).
Instant pulmonary vein isolation (PVI) was achieved in 117 patients,
while LAAC with Watchman device failed in 2 patients who had oversized
LAA ostium. During procedure, totally 9 patients, 7 with Watchman and 2
with LAmbre, required redeployment. Instant minimal residual flow was
observed in 2 patients with Watchman device (Figure 3 A & B) .
No other complications occurred. Procedure details are listed inTable 2 .
For 96 patients with available TEE image series, acute LAR lesion was
observed via TEE in almost every patient (99.0%). TEE measurement
showed that LAR had a greater increase in width (Δwidth=3.6±2.3 mm, 45°)
than thickness (Δthickness=2.6±3.5 mm, 45°). Correspondingly, the outer
ostium was significantly narrowed (Δouter ostium diameter=-3.4±4.0 mm,
45°). However, the inner ostium remained unchanged (Δinner ostium
diameter=0.4±2.2 mm, 45°). During follow-up, the lesion subsided and LAR
recovered to its original width but not thickness. The LAR profile is
depicted in Figure 2. Analysis of the association of LAR lesion
size with multiple variables showed that, only LSPV nadir temperature
positively correlated with over 2-fold wider LAR lesion at 45° (crude
odds ratio (OR)=1.12, 95% confidence interval (CI) 1.02-1.23). Such
association was still significant after adjustment (adjusted OR=1.16,
95%CI 1.02-1.31). details are presented in Table 3 .
The influence of acute LAR lesion on LAAC was revealed by TEE. In the
3rd month, Residual flow was observed in 6 patients, 4
with Watchman and 2 with LAmbre. All four cases with Watchman device had
minimal residual flow (0.9-2.1 mm) at the inferior border at 135°
(Figure 3 A-D ), while 2 cases of LAmbre device developed
relatively larger (2.5 mm and 4.2 mm) residual flows at the LAR border
at 90° (Figure 3 E & F ). Besides, through a mean follow-up
time of 626.4±212.2 days, survival analysis showed that there was no
difference between mild and severe LAR lesion groups on AA recurrence
and rehospitalization. (Figure 4 ). And the clinical outcomes
were similar between groups, as listed in Table 4 .