201
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Jhand A, Thandra A, Gwon Y, Turagam MK, Ashwath M, Yadav P, Alenezi F, Garg J, Abbott JD, Lakkireddy D, Parikh M, Sommer R, Velagapudi P. Intracardiac echocardiography versus transesophageal echocardiography for left atrial appendage closure: an updated meta-analysis and systematic review. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:538-547. [PMID: 33489456 PMCID: PMC7811919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
Intracardiac echocardiography (ICE) has emerged as an alternative to transesophageal echocardiography (TEE) to guide implantation of percutaneous left atrial appendage closure (LAAC) devices in patients with atrial fibrillation (AF) and a high bleeding risk. We reviewed the efficacy and safety of ICE compared to TEE in LAAC in this updated meta-analysis. Medline, CINAHL, EMBASE and Scopus were systematically searched for studies comparing ICE and TEE in percutaneous LAAC. Our primary outcomes of interest were procedural success and study reported periprocedural complications. Secondary outcomes included various procedural characteristics. Risk ratios (RR), standardized mean differences (SMD) and their corresponding 95% confidence intervals (CI) were calculated. The analysis was performed using a random-effect model. Nine observational studies met our inclusion criteria with a total of 2620 patients (ICE: 679 and TEE: 1941). Mean CHA2DS2-Vasc (4.4 ± 0.3 for ICE vs 4.5 ± 0.3 for TEE, P = 0.60) and HAS-BLED (3.2 ± 0.4 vs 3.1 ± 0.6, P = 0.78) scores were comparable between the two groups. There was no significant difference in procedure success rate (RR: 1.01, 95% CI: 0.99-1.02, P= 0.31) and periprocedural complications (RR: 0.85, 95% CI: 0.59-1.23, P = 0.39). No significant difference was observed in procedure duration, fluoroscopy time and contrast volume used while a trend towards decreased hospital length of stay was seen with the use of ICE. Thus, our updated meta-analysis shows ICE is as effective and safe as TEE for implantation of LAAC devices.
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Affiliation(s)
- Aravdeep Jhand
- Division of Cardiology, University of Nebraska Medical CenterOmaha, NE, USA
| | - Abhishek Thandra
- Division of Cardiology, Creighton University School of MedicineOmaha, NE, USA
| | - Yeongjin Gwon
- Department of Biostatistics, College of Public Health, University of Nebraska Medical CenterOmaha, NE, USA
| | - Mohit K Turagam
- Division of Cardiac Electrophysiology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | | | - Pradeep Yadav
- Interventional Cardiology, Marcus Heart Valve Center, Piedmont HospitalAtlanta, GA, USA
| | | | - Jalal Garg
- Division of Cardiovascular Medicine, Medical College WisconsinMilwaukee, WI, USA
| | - J Dawn Abbott
- Division of Cardiology, Brown UniversityProvidence, RI, USA
| | | | | | - Robert Sommer
- Division of Cardiology, Columbia University Medical CenterNew York, NY, USA
| | - Poonam Velagapudi
- Division of Cardiology, University of Nebraska Medical CenterOmaha, NE, USA
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202
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Singh GD, Rogers JH, Saw J. Watchman FLX: Early "Real World" Experience in Search for the Perfect Closure. JACC Cardiovasc Interv 2020; 13:2742-2744. [PMID: 33189646 DOI: 10.1016/j.jcin.2020.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA.
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - Jacqueline Saw
- Division of Cardiovascular Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
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203
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NCDR Left Atrial Appendage Occlusion Registry: The "Watch" Man Has Arrived. J Am Coll Cardiol 2020; 75:1519-1522. [PMID: 32238317 DOI: 10.1016/j.jacc.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 11/21/2022]
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204
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Masroor S, Qiu Q, Alghothani M, Gupta R, Moukarbel GV. Left atrial appendage perforation with Watchman device implantation: Strategies for surgical repair. J Card Surg 2020; 36:398-400. [PMID: 33259077 DOI: 10.1111/jocs.15145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
Percutaneous occlusion of the left atrial appendage is increasingly being used as an alternative for stroke prevention in patients with non-valvular atrial fibrillation at high risk of complications from long term anticoagulation. We describe a case of left atrial appendage perforation during Watchman device implantation requiring emergency repair of the left atrium using sternotomy and cardiopulmonary bypass. Technical considerations for surgical decision making are discussed; in hemodynamically unstable patients as well as those at high risk for embolization.
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Affiliation(s)
- Saqib Masroor
- Division of Cardiothoracic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Qiong Qiu
- Division of Cardiothoracic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Mohamad Alghothani
- Division of Cardiovascular Medicine, University of Toledo College of Medicine and Life Sciences, Tboledo, Ohio, USA
| | - Rajesh Gupta
- Division of Cardiovascular Medicine, University of Toledo College of Medicine and Life Sciences, Tboledo, Ohio, USA
| | - George V Moukarbel
- Division of Cardiovascular Medicine, University of Toledo College of Medicine and Life Sciences, Tboledo, Ohio, USA
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205
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Munir MB, Khan MZ, Darden D, Pasupula DK, Balla S, Han FT, Reeves R, Hsu JC. Contemporary procedural trends of Watchman percutaneous left atrial appendage occlusion in the United States. J Cardiovasc Electrophysiol 2020; 32:83-92. [PMID: 33155356 DOI: 10.1111/jce.14804] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/21/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine trends in real-world utilization and in-hospital adverse events from Watchman implantation since its approval by the Food and Drug Administration in 2015. BACKGROUND The risk of embolic stroke caused by atrial fibrillation is reduced by oral anticoagulants, but not all patients can tolerate long-term anticoagulation. Left atrial appendage occlusion with the Watchman device has emerged as an alternative therapy. METHODS This was a retrospective cohort study utilizing data from National Inpatient Sample for calendar years 2015-2017. The outcomes assessed in this study were associated complications, in-hospital mortality, and resource utilization trends after Watchman implantation. Trends analysis were performed using analysis of variance. Multivariable adjusted logistic regression analysis was performed to determine predictors of mortality. RESULTS A total of 17 700 patients underwent Watchman implantation during the study period. There was a significantly increased trend in the number of Watchman procedures performed over the study years (from 1195 in 2015 to 11 165 devices in 2017, p < .01). A significant decline in the rate of complications (from 26.4% in 2015% to 7.9% in 2017, p < .01) and inpatient mortality (from 1.3% in 2015% to 0.1% in 2017, p < .01) were noted. Predictors of in-hospital mortality included a higher CHA2 DS2 -VASc score (odds ratio [OR]: 2.61 per 1-point increase, 95% confidence interval [CI]: 1.91-3.57), chronic blood loss anemia (OR: 3.63, 95% CI: 1.37-9.61) and coagulopathy (OR: 4.90, 95% CI: 2.32-10.35). CONCLUSION In contemporary United States clinical practice, Watchman utilization has increased significantly since approval in 2015, while complications and in-patient mortality have declined.
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Affiliation(s)
- Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Douglas Darden
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Deepak K Pasupula
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Frederick T Han
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Ryan Reeves
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Jonathan C Hsu
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California, USA
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206
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Yu J, Bai Y, Jiang LS. Device related thrombus after left atrial appendage closure: State of the art. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:1253-1258. [PMID: 33165978 DOI: 10.1111/pace.14122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/09/2020] [Accepted: 11/07/2020] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation (AF), the most common arrhythmia, is a major cause of stroke and systemic embolism. Patients with AF are at higher risk of stroke with the left atrial appendage (LAA) being the most common site for thrombus formation. Although oral anticoagulation (OAC) remains the standard of care for stroke prevention in AF patients, there are still several limitations, including increased risk of bleeding and noncompliance. LAA closure (LAAC) has been found to be non-inferior to OAC in preventing all-cause strokes and systemic embolisms in randomized clinical trials, and is increasingly performed for stroke prevention in patients with nonvalvular AF (NVAF). However, device-related thrombus (DRT) after LAAC and a potentially increased risk of stroke related to DRT were observed in several registered studies, and attract wide concern. This review provides a comprehensive update on the incidence, mechanism, risk factors, prevention, diagnosis, and treatment of DRT after LAAC in patients with NVAF.
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Affiliation(s)
- Jiangtao Yu
- Clinic for General Internal Medicine and Cardiology, Katholisches Klinikum Koblenz Montabaur, Koblenz, Germany
| | - Yuan Bai
- Department of Cardiology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Li-Sheng Jiang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
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207
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Short-Term Apixaban for Documented Left Atrial Appendage Thrombus in High-Risk Atrial Fibrillation Patients Undergoing Left Atrial Appendage Occlusion. TH OPEN 2020; 4:e351-e353. [PMID: 33145476 PMCID: PMC7603420 DOI: 10.1055/s-0040-1718585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/07/2020] [Indexed: 10/29/2022] Open
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208
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The Extended Utility of CHA2DS2VASc and HAS-BLED Scores in the Selection for Transcutaneous Left Atrial Appendage Closure. J Clin Med 2020; 9:jcm9113438. [PMID: 33114743 PMCID: PMC7692802 DOI: 10.3390/jcm9113438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background and purpose: Left atrial appendage closure (LAAC) is an option for stroke prevention in atrial fibrillation patients. Randomized studies have demonstrated the effectiveness and safety of LAAC but included patients with an average risk of stroke and bleeding complications. The current study aimed to assess the extended utility of CHA2DS2VASc (congestive heart failure; hypertension; age ≥75 years [doubled]; type 2 diabetes; previous stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65 to 75 years; and sex category) and HAS-BLED (hypertension; abnormal renal/liver function; stroke; bleeding history or predisposition; labile INR, elderly, drugs/alcohol concomitantly) scores for qualification and prognosis after LAAC. Methods: The study population comprised 270 patients aged 72.8 ± 8.78 years. The occluders used were the Amplatzer Amulet (N = 205), Amplatzer Cardiac Plug (N = 53), and Watchman device (N = 12). The prognosis after LAAC was analyzed for different cohorts of patients distinguished based on different CHA2DS2VASc and HAS-BLED scores. The mean duration of follow-up was 21.6 ± 10.3 months. Results: The observed rates of ischemic stroke and bleeding were much lower than that expected (2.2% vs. 5.6%, and 0.76% vs. 6.05%, respectively). The mortality rate did not differ concerning the CHA2DS2CVASc score. It was significantly lower (8.3%) for HAS-BLED < 3, and it raised to 17.9% for HAS-BLED = 3 and to 25.9% for HAS-BLED > 3. Significant differences (p = 0.003) occurred for Kaplan–Meier curves for extreme HAS-BLED subgroups. A composite endpoint was most often found in high/very high risk of bleeding patients. Conclusions: HAS-BLED, but not CHA2DS2CVASc score, may be a useful tool to predict the prognosis of patients after LAAC. Qualification for LAAC based on the risk of stroke should not differ from qualification for anticoagulation. Despite the worse prognosis of patients with the highest bleeding risk, this group is likely to experience the greatest benefit from reducing the bleeding risk from LAAC.
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209
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Osman M, Patel B, Munir MB, Kawsara A, Kheiri B, Balla S, Daggubati R, Michos ED, Alkhouli M. Sex-stratified analysis of the safety of percutaneous left atrial appendage occlusion. Catheter Cardiovasc Interv 2020; 97:885-892. [PMID: 33048417 DOI: 10.1002/ccd.29282] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES AND BACKGROUND There is insufficient current evidence about whether sex impacts outcomes of percutaneous left atrial appendage occlusion (LAAO). The aim of this study was to investigate the association between sex and short-term outcomes of LAAO. METHODS Patients who were hospitalized and underwent LAAO from October 2015 to December 2017 in the National Readmission Database were queried. The primary endpoint of interest was major in-hospital adverse events. Secondary endpoints included, 30-day readmission rate, nonhome discharge, and cost of hospitalization. Propensity score matching (1:1) was performed to compare the outcomes among women and men. RESULTS A total of 9,281 patients were included in the current analysis [women = 3,659 (39%); men = 5,622 (61%)]. Comparing women to men, women had lower prevalence of diabetes mellitus (30.6% vs 35.7%, p < .01), heart failure (28.6% vs 30.8%, p = .03), vascular disease (55.5% vs 69.6%, p < .01) and renal failure (18.3% vs 21.2%, p < .01), and higher CHA2 DS2 VASc score (5 [IQR4-6] vs 4 [IQR3-6], p < .01). After propensity-score matching, women had higher rate of major in-hospital adverse events (2.8% vs 1.9%; p < .01), and nonhome discharges (11.4% vs 6.7%; p < .01). Additionally, 30-day readmission rate was higher among women (10% vs 8.6%, p = .03). CONCLUSION Among hospitalized patients undergoing LAAO, women carry higher risk for major in-hospital adverse events, nonhome discharge, and 30-day readmission rates.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Brijesh Patel
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Muhammad Bilal Munir
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA.,Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Ramesh Daggubati
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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210
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Meta-analysis of Left Atrial Appendage Closure Versus Anticoagulation in Patients With Atrial Fibrillation. Am J Cardiol 2020; 132:181-182. [PMID: 32778338 DOI: 10.1016/j.amjcard.2020.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/17/2020] [Indexed: 11/20/2022]
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211
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Alkhouli M, Holmes DR. Remaining Challenges With Transcatheter Left Atrial Appendage Closure. Mayo Clin Proc 2020; 95:2244-2248. [PMID: 33012352 PMCID: PMC7528944 DOI: 10.1016/j.mayocp.2020.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/19/2020] [Accepted: 07/10/2020] [Indexed: 01/01/2023]
Abstract
Left atrial appendage closure has emerged as a feasible stroke prevention strategy in selected patients with nonvalvular atrial fibrillation. Since its commercial approval in the United States in 2015, the use of percutaneous left atrial appendage closure has witnessed a substantial growth. However, certain issues remain unresolved with the technology. Knowledge of these issues, their significance, and the current and future efforts to resolve them is key for proper informed decision making by physicians and patients.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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212
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Kleinecke C, Gloekler S, Meier B. Utilization of percutaneous left atrial appendage closure in patients with atrial fibrillation: an update on patient outcomes. Expert Rev Cardiovasc Ther 2020; 18:517-530. [DOI: 10.1080/14779072.2020.1794820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Caroline Kleinecke
- Cardiology, Internal Medicine Department, Klinikum Lichtenfels, Lichtenfels, Germany
| | - Steffen Gloekler
- Cardiology, Internal Medicine Department, Klinikum Hochrhein, Waldshut-Tiengen, Germany and Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
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213
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Murtaza G, Boda U, Turagam MK, Della Rocca DG, Akella K, Gopinathannair R, Lakkireddy D. Risks and Benefits of Removal of the Left Atrial Appendage. Curr Cardiol Rep 2020; 22:129. [PMID: 32910248 DOI: 10.1007/s11886-020-01387-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW In patients with atrial fibrillation who are unable to take novel oral anticoagulants for stroke prophylaxis due to bleeding risk or other contraindications, left atrial appendage (LAA) occlusion and exclusion devices have shown benefit. In this review, we highlight the risks and benefits associated with LAA removal. RECENT FINDINGS LAA, once considered a vestigial organ, has been shown to have physiological, anatomical, and arrhythmogenic properties. Device-related complications such as pericardial effusion, device embolization, device-related thrombus, while uncommon, are still present. With increased operator experience related to appendage occlusion, overall procedural complications have declined. Further refinements in device technology will help decrease complications. While benefits of appendage removal are plenty, procedural complications need to be weighed into the equation when making decisions regarding LAA occlusion.
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Affiliation(s)
- Ghulam Murtaza
- The Kansas City Heart Rhythm Institute (KCHRI) & Research Foundation, Overland Park Regional Medical Center, HCA MidWest, 12200, W 106th Street, Overland Park, KS, 66215, USA
| | - Urooge Boda
- The Kansas City Heart Rhythm Institute (KCHRI) & Research Foundation, Overland Park Regional Medical Center, HCA MidWest, 12200, W 106th Street, Overland Park, KS, 66215, USA
| | - Mohit K Turagam
- Department of Cardiovascular Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Krishna Akella
- The Kansas City Heart Rhythm Institute (KCHRI) & Research Foundation, Overland Park Regional Medical Center, HCA MidWest, 12200, W 106th Street, Overland Park, KS, 66215, USA
| | - Rakesh Gopinathannair
- The Kansas City Heart Rhythm Institute (KCHRI) & Research Foundation, Overland Park Regional Medical Center, HCA MidWest, 12200, W 106th Street, Overland Park, KS, 66215, USA
| | - Dhanunjaya Lakkireddy
- The Kansas City Heart Rhythm Institute (KCHRI) & Research Foundation, Overland Park Regional Medical Center, HCA MidWest, 12200, W 106th Street, Overland Park, KS, 66215, USA.
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214
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Treatment Effects of Left Atrial Appendage Occlusion. JACC Cardiovasc Interv 2020; 13:2109-2111. [DOI: 10.1016/j.jcin.2020.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/17/2022]
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215
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Ding WY, Mandrola J, Gupta D. Left Atrial Appendage Occlusion: Past, Present and Future. Thromb Haemost 2020; 120:1484-1491. [DOI: 10.1055/s-0040-1714654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AbstractThere are several situations whereby oral anticoagulation may be unsuitable for stroke prevention in patients with atrial fibrillation (AF). Percutaneous left atrial appendage (LAA) occlusion has received much attention in this area. Various devices have already been developed and tested for this purpose. Data from registries and cohort studies have indicated favourable short- and long-term outcomes with LAA occlusion, and several international guidelines recommend its use in AF patients with contraindications to oral anticoagulation. However, prospective controlled trials in this very population are lacking. Furthermore, while modelling studies on cost analyses have suggested that LAA occlusion may be a cost-effective strategy compared with standard medical therapy, these have not been performed in high-risk patients who may have limited survival in the medium to long term. Thus, while LAA occlusion offers promise, there is a strong need for additional research to investigate its exact role, its long-term outcomes and cost efficacy.
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Affiliation(s)
- Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, Department of Cardiology, University of Liverpool, Liverpool, United Kingdom
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - John Mandrola
- Department of Cardiology, Baptist Health Louisville, Louisville, Kentucky, United States
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, Department of Cardiology, University of Liverpool, Liverpool, United Kingdom
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
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216
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Haussig S, Linke A, Mangner N. Cerebral Protection Devices during Transcatheter Interventions: Indications, Benefits, and Limitations. Curr Cardiol Rep 2020; 22:96. [PMID: 32651654 PMCID: PMC7351861 DOI: 10.1007/s11886-020-01335-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose of Review Stroke remains a devastating complication of cardiovascular interventions. This review is going to discuss stroke rates and outcomes in different cardiovascular procedures with a highlight on the current evidence for the use of cerebral protection devices (CPD). Recent Findings Depending on the quality of neurological assessment, stroke occurs in up to 9.1% after TAVI, 3.9% after mitral clipping, 3.1% in LAAO patients, 0.4% after PCIs, and 1.8% after catheter ablation. CPDs are available for routine use. They are easy to use in most anatomies, feasible, and safe. Data on clinical impact and stroke reduction from RCTs are still missing. Summary Most evidence for the routine use of CPDs exists in TAVI patients, who are at the highest risk. The PROTECTED TAVI RCT will shed more light on the clinical impact of CPD-use in TAVI patients. In other cardiovascular procedures like mitral clipping, PCIs, and ablation, the current data do not support the routine use of CPDs in these patients.
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Affiliation(s)
- Stephan Haussig
- Herzzentrum Dresden, University Clinic, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Fetscherstr, 76, 01307, Dresden, Germany.
| | - Axel Linke
- Herzzentrum Dresden, University Clinic, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Fetscherstr, 76, 01307, Dresden, Germany
| | - Norman Mangner
- Herzzentrum Dresden, University Clinic, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Fetscherstr, 76, 01307, Dresden, Germany
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217
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Price MJ, Saw J. Transcatheter Left Atrial Appendage Occlusion in the DOAC Era. J Am Coll Cardiol 2020; 75:3136-3139. [DOI: 10.1016/j.jacc.2020.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
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