1
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Tang GHL, Zaid S, Hahn RT, Aggarwal V, Alkhouli M, Aman E, Berti S, Chandrashekhar YS, Chadderdon SM, D'Agostino A, Fam NP, Ho EC, Kliger C, Kodali SK, Krishnamoorthy P, Latib A, Lerakis S, Lim DS, Mahadevan VS, Nair DG, Narula J, O'Gara PT, Packer DL, Praz F, Rogers JH, Ruf TF, Sanchez CE, Sharma A, Singh GD, van Mieghem NM, Vannan MA, Yadav PK, Ya'Qoub L, Zahr FE, von Bardeleben RS. Structural Heart Imaging Using 3-Dimensional Intracardiac Echocardiography: JACC Cardiovascular Imaging Position Statement. JACC Cardiovasc Imaging 2024:S1936-878X(24)00202-X. [PMID: 38970594 DOI: 10.1016/j.jcmg.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 07/08/2024]
Abstract
3-dimensional (3D) intracardiac echocardiography (ICE) is emerging as a promising complement and potential alternative to transesophageal echocardiography for imaging guidance in structural heart interventions. To establish standardized practices, our multidisciplinary expert position statement serves as a comprehensive guide for the appropriate indications and utilization of 3D-ICE in various structural heart procedures. The paper covers essential aspects such as the fundamentals of 3D-ICE imaging, basic views, and workflow recommendations specifically tailored for ICE-guided structural heart procedures, such as transeptal puncture, device closure of intracardiac structures, and transcatheter mitral and tricuspid valve interventions. Current challenges, future directions, and training requirements to ensure operator proficiency are also discussed, thereby promoting the safety and efficacy of this innovative imaging modality to support expanding its future clinical applications.
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Affiliation(s)
| | - Syed Zaid
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA
| | - Vratika Aggarwal
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Edris Aman
- University of California, Davis Medical Center, Sacramento, California, USA
| | - Sergio Berti
- G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Y S Chandrashekhar
- Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | - Neil P Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Edwin C Ho
- Montefiore Medical Center, Bronx, New York, USA
| | - Chad Kliger
- Lenox Hill Hospital, New York, New York, USA
| | - Susheel K Kodali
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | | | - D Scott Lim
- University of Virginia, Charlottesville, Virginia, USA
| | - Vaikom S Mahadevan
- University of Massachusetts Chan School of Medicine, Worchester, Massachusetts, USA
| | - Devi G Nair
- St. Bernard's Heart and Vascular Center, Jonesboro, Arkansas, USA
| | - Jagat Narula
- University of Texas Health Houston, Houston, Texas, USA
| | | | | | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jason H Rogers
- University of California, Davis Medical Center, Sacramento, California, USA
| | | | | | - Alok Sharma
- Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gagan D Singh
- University of California, Davis Medical Center, Sacramento, California, USA
| | | | | | | | - Lina Ya'Qoub
- University of California, San Francisco Medical Center, San Francisco, California, USA
| | - Firas E Zahr
- Oregon Health and Science University, Portland, Oregon, USA
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2
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Golzarian H, Pasley BA, Shah SR, Thiel AM, Knous M, Kleman AC, Saum JL, Hempfling GL, Otto M, Otto T, Racer L, Martz D, Gemmel DJ, Laird AD, Cole WC, Parsa P, Imm C, Patel SM. Single-Operator Left atrial appendage Occlusion utilizing Conscious sedation TEE, Lack of Outpatient pre-imaging, and Same-day Expedited discharge (SOLO-CLOSE): A comparison with conventional approach. Catheter Cardiovasc Interv 2024. [PMID: 38736248 DOI: 10.1002/ccd.31073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Left atrial appendage occlusion (LAAO) with WATCHMAN currently requires preprocedural imaging, general anesthesia, and inpatient overnight admission. We sought to facilitate simplification of LAAO. AIMS We describe and compare SOLO-CLOSE (single-operator LAA occlusion utilizing conscious sedation TEE, lack of outpatient pre-imaging, and same-day expedited discharge) with the conventional approach (CA). METHODS A single-center retrospective analysis of 163 patients undergoing LAAO between January 2017 and April 2022 was conducted. The SOLO-CLOSE protocol was enacted on December 1, 2020. Before this date, we utilized the CA. The primary efficacy endpoint was defined as successful LAAO with ≤5 mm peri-device leak at time of closure. The primary safety endpoint was the composite incidence of all-cause deaths, any cerebrovascular accident (CVA), device embolization, pericardial effusion, or major postprocedure bleeding within 7 days of the index procedure. Procedure times, 7-day readmission rates, and cost analytics were collected as well. RESULTS Baseline characteristics were similar in both cohorts. Congestive heart failure (37.5% vs. 11.1%) and malignancy (28.8% vs. 12.5%) were higher in SOLO-CLOSE. Median CHA2D2SVASc score was 5 in both cohorts. The primary efficacy endpoint was met 100% in both cohorts. Primary safety endpoint was similar between cohorts (p = 0.078). Mean procedure time was 30 min shorter in SOLO-CLOSE (p < 0.01). Seven-day readmissions for SOLO-CLOSE was zero. After SOLO-CLOSE implementation, there was a 188% increase in positive contribution margin per case. CONCLUSIONS The SOLO-CLOSE methodology offers similar efficacy and safety when compared to the CA, while improving clinical efficiency, reducing procedural times, and increasing economic benefit.
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Affiliation(s)
- Hafez Golzarian
- Department of Internal Medicine, Internal Medicine Residency Program, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Benjamin A Pasley
- Department of Internal Medicine, Internal Medicine Residency Program, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Sidra R Shah
- Department of Internal Medicine, Internal Medicine Residency Program, Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Arielle M Thiel
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Mallory Knous
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Anna C Kleman
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Jamie L Saum
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Gerri L Hempfling
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Michael Otto
- Department of Cardiothoracic & Vascular Surgery, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Todd Otto
- Department of Cardiothoracic & Vascular Surgery, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Lisa Racer
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Denise Martz
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - David J Gemmel
- Department of Internal Medicine, Graduate Medical Education Research, Bon Secours Mercy Health-St. Elizabeth Youngstown Hospital, Youngstown, Ohio, USA
| | - Amanda D Laird
- Department of Critical Care, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - William C Cole
- Department of Critical Care, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Prabhakar Parsa
- Department of Anesthesia, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Craig Imm
- Department of Anesthesia, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
| | - Sandeep M Patel
- Department of Cardiology, Structural Heart & Intervention Center, Bon Secours Mercy Health-St. Rita's Medical Center, Lima, Ohio, USA
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3
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01771-5. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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4
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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5
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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6
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Heidari H, Kanschik D, Maier O, Wolff G, Brockmeyer M, Masyuk M, Bruno RR, Polzin A, Erkens R, Antoch G, Reinartz SD, Werner N, Kelm M, Zeus T, Afzal S, Jung C. A comparison of conventional and advanced 3D imaging techniques for percutaneous left atrial appendage closure. Front Cardiovasc Med 2024; 11:1328906. [PMID: 38596690 PMCID: PMC11002144 DOI: 10.3389/fcvm.2024.1328906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
Background Understanding complex cardiac anatomy is essential for percutaneous left atrial appendage (LAA) closure. Conventional multi-slice computed tomography (MSCT) and transesophageal echocardiography (TEE) are now supported by advanced 3D printing and virtual reality (VR) techniques for three-dimensional visualization of volumetric data sets. This study aimed to investigate their added value for LAA closure procedures. Methods Ten patients scheduled for interventional LAA closure were evaluated with MSCT and TEE. Patient-specific 3D printings and VR models were fabricated based on MSCT data. Ten cardiologists then comparatively assessed LAA anatomy and its procedure relevant surrounding structures with all four imaging modalities and rated their procedural utility on a 5-point Likert scale questionnaire (from 1 = strongly agree to 5 = strongly disagree). Results Device sizing was rated highest in MSCT (MSCT: 1.9 ± 0.8; TEE: 2.6 ± 0.9; 3D printing: 2.5 ± 1.0; VR: 2.5 ± 1.1; p < 0.01); TEE, VR, and 3D printing were superior in the visualization of the Fossa ovalis compared to MSCT (MSCT: 3.3 ± 1.4; TEE: 2.2 ± 1.3; 3D printing: 2.2 ± 1.4; VR: 1.9 ± 1.3; all p < 0.01). The major strength of VR and 3D printing techniques was a superior depth perception (VR: 1.6 ± 0.5; 3D printing: 1.8 ± 0.4; TEE: 2.9 ± 0.7; MSCT: 2.6 ± 0.8; p < 0.01). The visualization of extracardiac structures was rated less accurate in TEE than MSCT (TEE: 2.6 ± 0.9; MSCT: 1.9 ± 0.8, p < 0.01). However, 3D printing and VR insufficiently visualized extracardiac structures in the present study. Conclusion A true 3D visualization in VR or 3D printing provides an additional value in the evaluation of the LAA for the planning of percutaneous closure. In particular, the superior perception of depth was seen as a strength of a 3D visualization. This may contribute to a better overall understanding of the anatomy. Clinical studies are needed to evaluate whether a more comprehensive understanding through advanced multimodal imaging of patient-specific anatomy using VR may translate into improved procedural outcomes.
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Affiliation(s)
- Houtan Heidari
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Dominika Kanschik
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Oliver Maier
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Maximilian Brockmeyer
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Maryna Masyuk
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Ralf Erkens
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Sebastian Daniel Reinartz
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Nikos Werner
- Department of Cardiology, Heartcenter Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
- Department of Cardiology, Heartcenter Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
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7
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Malhotra P. Use of Computed Tomography for Left Atrial Appendage Occlusion Procedure Planning and Post-Procedure Assessment. Interv Cardiol Clin 2024; 13:19-28. [PMID: 37980064 DOI: 10.1016/j.iccl.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Transcatheter left atrial appendage occlusion (LAAO) is an alternative to systemic anticoagulation in patients with non-valvular atrial fibrillation with increased risk for thromboembolic events. Pre- and post-procedural imaging is essential for technical success, allowing practitioners to identify contraindications, select appropriate devices, and recognize procedural complications. Although transesophageal echocardiography has traditionally served as the preeminent imaging modality in LAAO, cardiac computed tomography imaging has emerged as a noninvasive surrogate given its excellent isotropic spatial resolution, multiplanar reconstruction capability, rapid temporal resolution, and large field of view.
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Affiliation(s)
- Pankaj Malhotra
- Department of Imaging, Mark Taper Imaging Center, Cedars Sinai Medical Center, 8700 Beverly Boulevard, Taper M335, Los Angeles, CA 90048, USA; Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
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8
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Awadallah D, Elrifay A, Awad H, Anam K, Augostini R, Bhandary S. Left Atrial Appendage Occlusion Procedure: Transesophageal Echocardiography versus Intracardiac Echocardiography-Pro: Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2024; 38:320-323. [PMID: 37852912 DOI: 10.1053/j.jvca.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 04/14/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023]
Affiliation(s)
| | - Amr Elrifay
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hamdy Awad
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Karina Anam
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ralph Augostini
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sujatha Bhandary
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.
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9
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Jiang X, Xiong Q, Yin Y, Ling Z. Left atrial appendage closure for stroke prevention in atrial fibrillation patients: A promise that came true. Pacing Clin Electrophysiol 2023; 46:1576-1585. [PMID: 37987556 DOI: 10.1111/pace.14877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
Anticoagulation therapy plays a crucial role in the management of atrial fibrillation (AF), considering the high morbidity and mortality of AF-related ischemic strokes. With the plausible hypothesis that left atrial appendage is the main source of thrombus in AF patients, left atrial appendage closure (LAAC) has been regarded as a potential substitute to oral anticoagulation in order to meet the unmet needs for stroke prevention, particularly in patients with high bleeding risk. Notable advancements in safety, efficacy, and device innovation have been made in recent years, albeit concerns still remain regarding the insufficient efficacy data, device-related complications, and the need for procedural optimization. We aim to review current knowledge about LAAC and provide potential future directions for the remaining key issues.
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Affiliation(s)
- Xi Jiang
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingsong Xiong
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuehui Yin
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiyu Ling
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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10
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Lu X, Wang X, Wang Q, Song T, Liu G, Liu A, Shi X, Guo J, Chen T. Efficiency of optimal fluoroscopic projection angle defined by computed tomography angiography for left atrial appendage closure. Hellenic J Cardiol 2023:S1109-9666(23)00179-3. [PMID: 37717695 DOI: 10.1016/j.hjc.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/24/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Left atrial appendage (LAA) closure (LAAC) procedures are conventionally performed using empirical fluoroscopic viewing angles. However, because the LAA is a highly variable anatomical structure, these angles cannot depict the LAA in the optimal position. The present study aimed to assess the efficiency of using a novel optimal fluoroscopic projection angle (OPA) for LAAC and to validate its feasibility. METHODS The OPAs of the derivation cohort were acquired using cardiac computed tomography angiography (CCTA) to assess its superiority for depicting LAA depth versus traditional working angles (TAs) of RAO 30°, CAU 20°. The practicability of OPA-guided LAAC was demonstrated by comparison between clinical data from the validation cohort and those from a propensity-score matched (PSM) control group, as well as randomized controlled studies investigating LAAC. RESULTS Of 705 patients in the derivation cohort, the median OPA was RAO 46°, CAU 31°. Compared with TA, the OPA depicted a longer mean (±SD) LAA depth (5.1 ± 4.4) mm and a larger orifice diameter (1.1 ± 1.1 mm), (P < 0.0001 for both). All 38 OPA-guided LAACs were successful, with a shorter mean procedure duration (42.9 ± 12.3 min versus [vs.] 107.2 ± 41.5 min; P < 0.0001) and reduced device consumption (1.08 vs. 1.5 per case), compared with the PSM control group. At the 3-month follow-up, the incidence of peri-device leak was 52.6% (20/38) detected by CCTA, with a mean leakage of 1.6 ± 0.8 mm. CONCLUSION By unfolding the LAA depth and orifice diameter for a better view, OPA demonstrated the potential to optimize LAAC procedural efficiency, although further larger-scale studies are required to confirm this.
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Affiliation(s)
- Xu Lu
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China; Outpatient Department, The 44th Sanatorium of Retired Cadres in Haidian District, No. 19 Dahuisi Road, Haidian District, Beijing 100081, China.
| | - Xinyan Wang
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China.
| | - Qingsong Wang
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China.
| | - Tingting Song
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China.
| | - Ge Liu
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China.
| | - Ao Liu
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China.
| | - Xiangmin Shi
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China.
| | - Jun Guo
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China.
| | - Tao Chen
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China.
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11
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Chen Y, Chen Y, Lam YY, Wang L, Fang Y, Huang W, Xiao F. Intracardiac echocardiographic imaging with a cartosound module for guidance of left atrial appendage closure: a comparative study with transesophageal echocardiographic imaging. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1667-1675. [PMID: 37233916 DOI: 10.1007/s10554-023-02880-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE In most clinical trials, intracardiac echocardiography (ICE) has provided fewer views than the four standard views provided by transesophageal echocardiography (TEE) when assessing left atrial appendage closure (LAAC) devices. This study aimed to determine if ICE guided by the CartoSound system achieve adequate high-quality views and similar clinical outcomes as TEE during LAAC. METHODS This study prospectively enrolled 202 patients who underwent LAAC using either ICE (n = 69), TEE (n = 121), or a combination of ICE and TEE (n = 12) as the procedural imaging under local anesthesia. A novel multi-angled "FLAVOR" approach was used for assessment in the ICE group. RESULTS ICE allowed visualization of the implanted devices in all patients at all proposed angles with long-axis views while two-dimensional (2D) TEE showed short-axis views in 1 or 2 angles in 24.2% of cases, which was more prevalent when the pulmonary ridge was covered by the occluder. In the combined ICE-TEE cohort, 2D-TEE failed to detect peri-device leak in 1 patient. The complication rates were similar between the ICE and TEE groups. Shorter fluoroscopy time, lower radiation dose and contrast usage were founded in the ICE group. At first TEE follow-up, the rate and degree of peri-device leak were similar between the ICE and TEE groups. CONCLUSION A systematic ICE protocol using a CartoSound module to guide LAAC was reliable for comprehensive long-axis imaging assessment compared with 2D/3D TEE under local anesthesia with a shorter fluoroscopy time, lower radiation dose, and less use of contrast.
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Affiliation(s)
- Yanyan Chen
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, 325000, P.R. China
| | - Yihe Chen
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, 325000, P.R. China
| | - Yat-Yin Lam
- Hong Kong Asia Heart Center, Canossa Hospital, Canossa, 1 Old Peak Road, Hong Kong
| | - Liangguo Wang
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, 325000, P.R. China
| | - Ying Fang
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, 325000, P.R. China
| | - Weijian Huang
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, 325000, P.R. China
| | - Fangyi Xiao
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, 325000, P.R. China.
- Department of Cardiology, the Key Lab of Cardiovascular Disease of Wenzhou, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, 325000, P.R. China.
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12
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Margonato D, Rizza V, Ingallina G, Preda A, Ancona F, Belli M, Godino C, Agricola E, Della Bella P, Grasso C, Contarini M, Mazzone P. Left atrial appendage occlusion in the absence of intraprocedural product specialist monitoring: is it time to proceed alone? Results from a multicenter real-world experience. Front Cardiovasc Med 2023; 10:1172005. [PMID: 37383696 PMCID: PMC10293837 DOI: 10.3389/fcvm.2023.1172005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
Background Percutaneous left atrial appendage occlusion (LAAO) presents many technical complex features, and it is often performed under the intraprocedural surveillance of a product specialist (PS). Our aim is to assess whether LAAO is equally safe and effective when performed in high-volume centers without PS support. Methods Intraprocedural results and long-term outcome were retrospectively assessed in 247 patients who underwent LAAO without intraprocedural PS monitoring between January 2013 and January 2022 at three different hospitals. This cohort was then matched to a population who underwent LAAO with PS surveillance. The primary end point was all-cause mortality at 1 year. The secondary end point was a composite of cardiovascular mortality plus nonfatal ischemic stroke occurrence at 1 year. Results Of the 247 study patients, procedural success was achieved in 243 patients (98.4%), with only 1 (0.4%) intraprocedural death. After matching, we did not identify any significant difference between the two groups in terms of procedural time (70 ± 19 min vs. 81 ± 30 min, p = 0.106), procedural success (98.4% vs. 96.7%, p = 0.242), and procedure-related ischemic stroke (0.8% vs. 1.2%, p = 0.653). Compared to the matched cohort, a significant higher dosage of contrast was used during procedures without specialist supervision (98 ± 19 vs. 43 ± 21, p < 0.001), but this was not associated with a higher postprocedural acute kidney injury occurrence (0.8% vs. 0.4%, p = 0.56). At 1 year, the primary and the secondary endpoints occurred in 21 (9%) and 11 (4%) of our cohort, respectively. Kaplan-Meier curves showed no significant difference in both primary (p = 0.85) and secondary (p = 0.74) endpoint occurrence according to intraprocedural PS monitoring. Conclusions Our results show that LAAO, despite the absence of intraprocedural PS monitoring, remains a long-term safe and effective procedure, when performed in high-volume centers.
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Affiliation(s)
- Davide Margonato
- Department of Cardiovascular Imaging, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Vincenzo Rizza
- Department of Cardiovascular Imaging, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Giacomo Ingallina
- Department of Cardiovascular Imaging, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Alberto Preda
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Francesco Ancona
- Department of Cardiovascular Imaging, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Martina Belli
- Department of Cardiovascular Imaging, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Cosmo Godino
- Department of Clinical Cardiology, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Eustachio Agricola
- Department of Cardiovascular Imaging, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Carmelo Grasso
- Department of Cardiology, C.A.S.T., Azienda Ospedaliero Universitaria Policlinico “G. Rodolico-San Marco”, University of Catania, Catania, Italy
| | - Marco Contarini
- Department of Interventional Cardiology, Umberto I Hospital, Syracuse, Italy
| | - Patrizio Mazzone
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
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13
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Margonato D, Preda A, Ingallina G, Rizza V, Fierro N, Radinovic A, Ancona F, Patti G, Agricola E, Bella PD, Mazzone P. Left atrial appendage occlusion after thromboembolic events or left atrial appendage sludge during anticoagulation therapy: Is two better than one? Real-world experience from a tertiary care hospital. J Arrhythm 2023; 39:395-404. [PMID: 37324751 PMCID: PMC10264741 DOI: 10.1002/joa3.12838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The role of left atrial appendage occlusion (LAAO) for atrial fibrillation patients that during oral anticoagulant therapy (OAC) suffer from ischemic events or present LAA sludge, and the best postinterventional anticoagulant regimen, need to be defined. We present our experience with a hybrid approach of LAAO+ lifelong OAC therapy in this cohort of patients. METHODS Out of 425 patients treated with LAAO, 102 underwent LAAO because, despite OAC, suffered from ischemic events or presented with LAA sludge. Patients without high bleeding risk were discharged with the aim of maintaining lifelong OAC. This cohort was then matched to a population who underwent LAAO in primary ischemic events prevention. The primary endpoint was the composite of all-cause death and major adverse cardiovascular events consisting of ischemic stroke, systemic embolism (SE), and major bleeding. RESULTS Procedural success was 98%, and 70% of patients were discharged with anticoagulant therapy. After a median follow-up of 47.2 months, the primary endpoint occurred in 27 patients (26%). At multivariate analyses, coronary artery disease (OR 5.1, CI 1.89-14.27, p = .003) and OAC at discharge (OR 0.29, CI 0.11-0.80, p = .017) were associated with the primary endpoint. After propensity score matching, no significant difference was found in the survival free from the primary endpoint according to the indication for LAAO (p = .19). CONCLUSIONS In this high-ischemic risk cohort, LAAO + OAC seem a long-term safe and effective therapeutical approach, with no difference in the survival free from the primary endpoint according to the indication for LAAO in a matched cohort.
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Affiliation(s)
- Davide Margonato
- Department of Cardiovascular ImagingIRCCS San Raffaele Hospital and Vita‐Salute UniversityMilanItaly
| | - Alberto Preda
- Department of Cardiac Electrophysiology and ArrhythmologyIRCCS San Raffaele Hospital and Vita‐Salute UniversityMilanItaly
| | - Giacomo Ingallina
- Department of Cardiovascular ImagingIRCCS San Raffaele Hospital and Vita‐Salute UniversityMilanItaly
| | - Vincenzo Rizza
- Department of Cardiovascular ImagingIRCCS San Raffaele Hospital and Vita‐Salute UniversityMilanItaly
| | - Nicolai Fierro
- Department of Cardiac Electrophysiology and ArrhythmologyIRCCS San Raffaele Hospital and Vita‐Salute UniversityMilanItaly
- Department of Thoracic, Heart and Vascular DiseasesMaggiore della Carità HospitalNovaraItaly
| | - Andrea Radinovic
- Department of Cardiac Electrophysiology and ArrhythmologyIRCCS San Raffaele Hospital and Vita‐Salute UniversityMilanItaly
| | - Francesco Ancona
- Department of Cardiovascular ImagingIRCCS San Raffaele Hospital and Vita‐Salute UniversityMilanItaly
| | - Giuseppe Patti
- Department of Thoracic, Heart and Vascular DiseasesMaggiore della Carità HospitalNovaraItaly
| | - Eustachio Agricola
- Department of Cardiovascular ImagingIRCCS San Raffaele Hospital and Vita‐Salute UniversityMilanItaly
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and ArrhythmologyIRCCS San Raffaele Hospital and Vita‐Salute UniversityMilanItaly
| | - Patrizio Mazzone
- Department of Cardiac Electrophysiology and ArrhythmologyIRCCS San Raffaele Hospital and Vita‐Salute UniversityMilanItaly
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Wollborn J, Schuler A, Sheu RD, Shook DC, Nyman CB. Real-Time Multiplanar Reconstruction Imaging Using 3-Dimensional Transesophageal Echocardiography in Structural Heart Interventions. J Cardiothorac Vasc Anesth 2023; 37:570-581. [PMID: 36517335 DOI: 10.1053/j.jvca.2022.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
Abstract
The complexity of structural heart interventions has led to a demand for sophisticated periprocedural imaging guidance. Although traditional 2-dimensional (2D) transesophageal techniques are used widely, new-generation 3D ultrasound probes enable high temporal and spatial resolution. Multiplanar reconstruction of acquired 3D datasets has gained considerable momentum for precise imaging and to increase the validity of measurements. Previously, this technique was used after the acquisition of suitable 3D datasets. Recent advances in technology have enabled the use of live mode for multiplanar reconstruction across different ultrasound vendor platforms. The use of live multiplanar reconstruction can enhance the precision in real-time imaging, enable simultaneous visualization of structures of interest in multiple planes, reduce the need for probe manipulation, and thereby contribute to the success of the procedures. In this narrative review, the authors describe the rationale and utility for 3D transesophageal live multiplanar reconstruction, and outline its use for the structural heart interventions of mitral and tricuspid valve edge-to-edge repair, left atrial appendage occlusion, and the Lampoon procedure. A 3D transesophageal echocardiogram with live-multiplanar reconstruction has the potential to advance guidance of these complex interventions.
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Affiliation(s)
- Jakob Wollborn
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Andreas Schuler
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Richard D Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Douglas C Shook
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Charles B Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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15
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Maidman SD, Bamira D, Ro R, Vainrib AF, Saric M. Taking Command of Three-Dimensional Stitching Artifacts: From an Annoyance to an Easy Tool for Navigating Three-Dimensional Transesophageal Echocardiography. J Am Soc Echocardiogr 2023; 36:105-110. [PMID: 36174809 DOI: 10.1016/j.echo.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 01/10/2023]
Abstract
Despite many recent advances in three-dimensional (3D) transesophageal echocardiography (TEE) imagining, the process of orienting 3D TEE images is nonintuitive and uses assumptions based on idealized anatomy. Correlating two-dimensional TEE cross-sectional images to 3D reconstructions remains an additional challenge. In this article, we suggest the repurposing of the stitching artifact generated in 2-beat electrocardiogram-gated 3D TEE as a means of exactly orienting 3D images within a patient's unique anatomy. We demonstrate the application of this strategy to assess a normal mitral valve to localize scallops of mitral valve prolapse and to visualize typical left atrial appendage two-dimensional cuts in a 3D space. By taking command of stitching artifacts, cardiac imagers can successfully navigate the complex structures of the heart for optimal, individualized echocardiographic views.
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Affiliation(s)
- Samuel D Maidman
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Richard Ro
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York.
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Berti S, De Caterina AR, Grasso C, Casu G, Giacchi G, Pagnotta P, Maremmani M, Mazzone P, Limite L, Tomassini F, Greco F, Romeo MR, Caramanno G, Fassini G, Geraci S, Chiarito M, Tondo C, Tamburino C, Contarini M. Periprocedural outcome in patients undergoing left atrial appendage occlusion with the Watchman FLX device: The ITALIAN-FLX registry. Front Cardiovasc Med 2023; 10:1115811. [PMID: 37180775 PMCID: PMC10172664 DOI: 10.3389/fcvm.2023.1115811] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction The Watchman FLX is a novel device for transcatheter left atrial appendage occlusion (LAAO) specifically designed to improve procedural performance in more complex anatomies with a better safety profile. Recently, small prospective non-randomized studies have shown good procedural success and safety compared with previous experiences. Results from large multicenter registries are needed to confirm the safety and efficacy of the Watchman FLX device in a real-world setting. Methods Italian FLX registry is a retrospective, non-randomized, multicentric study across 25 investigational centers in Italy including consecutive patients undergoing LAAO with the Watchman FLX between March 2019 and September 2021 (N = 772). The primary efficacy outcome was the technical success of the LAAO procedure (peri-device flow ≤ 5 mm) as assessed by intra-procedural imaging. The peri-procedural safety outcome was defined as the occurrence of one of the following events within 7 days after the procedure or by hospital discharge: death, stroke, transient ischemic attack, major extracranial bleeding (BARC type 3 or 5), pericardial effusion with tamponade or device embolization. Results A total of 772 patients were enrolled. The mean age was 76 ± 8 with a mean CHA2DS2-VASc score of 4.1 ± 1.4 and a mean HAS-BLED score of 3.7 ± 1.1. Technical success was achieved in 772 (100%) patients with the first device implanted in 760 (98.4%) patients. A peri-procedural safety outcome event occurred in 21 patients (2.7%) with major extracranial bleeding being the most common (1.7%). No device embolization occurred. At discharge 459 patients (59.4%) were treated with dual antiplatelet therapy (DAPT). Conclusions The Italian FLX registry represents the largest multicenter retrospective real-world study reporting periprocedural outcome of LAAO with the Watchman FLX device, resulting in a procedural success rate of 100% and a low incidence of peri-procedural major adverse events (2.7%).
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Affiliation(s)
- Sergio Berti
- Fondazione Toscana G. Monasterio, Ospedale del Cuore G. Pasquinucci, Massa, Italy
- Correspondence: Sergio Berti
| | | | - Carmelo Grasso
- Cardiac-Thoracic-Vascular Department, Ferrarotto Hospital and University of Catania, Catania, Italy
| | - Gavino Casu
- Cardiology Unit, Ospedale San Francesco, Nuoro, Italy
| | | | - Paolo Pagnotta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Michele Maremmani
- Fondazione Toscana G. Monasterio, Ospedale del Cuore G. Pasquinucci, Massa, Italy
| | - Patrizio Mazzone
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Luca Limite
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Francesco Tomassini
- Unità interaziendale di emodinamica-Ospedale degli Infermi, Rivoli(To)-Ospedale San Luigi Gonzaga, Turin, Italy
| | | | - Maria Rita Romeo
- Fondazione Toscana G. Monasterio, Ospedale del Cuore G. Pasquinucci, Massa, Italy
| | | | - Gaetano Fassini
- Department of Clinical Electrophysiology & Cardiac Pacing Heart Rhythm Center at Monzino Cardiac Center, IRCCS, Milan, Italy
| | - Salvatore Geraci
- Interventional Cardiology Unit, Umberto I Hospital, Syracuse, Italy
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing Heart Rhythm Center at Monzino Cardiac Center, IRCCS, Milan, Italy
| | - Corrado Tamburino
- Cardiac-Thoracic-Vascular Department, Ferrarotto Hospital and University of Catania, Catania, Italy
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17
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Sun A, Ren S, Xiao Y, Chen Y, Wang N, Li C, Tan X, Pan Y, Sun F, Ren W. Real-time 3D echocardiographic transilluminated imaging combined with artificially intelligent left atrial appendage measurement for atrial fibrillation interventional procedures. Front Physiol 2022; 13:1043551. [PMID: 36439257 PMCID: PMC9681832 DOI: 10.3389/fphys.2022.1043551] [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: 09/13/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022] Open
Abstract
Aims: This study investigated the feasibility and accuracy of real-time three-dimensional (3D) echocardiographic transilluminated imaging (TrueVue Glass) in left atrial appendage (LAA) anatomical morphology and artificial intelligence (AI)-assisted 3D automated LAA measurement (3D Auto LAA) software in the preoperative evaluation of LAA occlusion (LAAO) in patients with atrial fibrillation (AF). Method and results: Thirty-seven patients with AF were selected. Two-dimensional (2D) and real-time 3D transesophageal echocardiography (RT3D-TEE) were performed preoperatively, using conventional 3D, the new 3D TrueVue Glass mode, and cardiac computed tomography angiography (CCTA) to assess and type the morphology of LAA. Physiological parameters were measured using traditional 2D and 3D manual (3D Manual LAA), 3D Auto LAA, and CCTA. TrueVue Glass for LAA outer contour display was compared with CCTA. Comparisons were based on correlation and consistency in measuring the maximum diameter (LZ max), minimum diameter (LZ min), area (LZ area), and circumference (LZ cir) of LAA landing zone (LZ). Times and variabilities were compared. The concordance rate for external shape of LAA was 97.14% between TrueVue Glass and CCTA. 3D Auto LAA and 3D Manual LAA have a stronger correlation and higher consistency in all parameters. 3D Auto LAA showed higher intra- and interobserver reproducibility and allowed quicker analysis (p < 0.05). LAAO was performed in 35 patients (94.59%), and none of which had serious adverse events. Conclusion: TrueVue Glass is the first non-invasive and radiation-free visualization of the overall external contour of LAA and its adjacent structures. 3D Auto LAA simplifies the measurement, making the preoperative assessment more efficient and convenient while ensuring the accuracy and reproducibility. A combination of the two is feasible for accurate and rapid assessment of LAA anatomy and physiology in AF patients and has practical application in LAAO.
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Affiliation(s)
- Aijiao Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Sihua Ren
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yixin Chen
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chendi Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xueying Tan
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yilong Pan
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Feifei Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Feifei Sun,
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Quintana RA, Dong T, Vajapey R, Reyaldeen R, Kwon DH, Harb S, Wang TKM, Klein AL. Intra- and Postprocedural Multimodality Imaging in Atrial Fibrillation. Circ Cardiovasc Imaging 2022; 15:e014804. [PMID: 36378776 DOI: 10.1161/circimaging.122.014804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Multi-modality imaging plays critical roles during and after procedures associated with atrial fibrillation. Transesophageal echocardiography is an invaluable tool for left atrial appendage occlusion during the procedure and at follow-up. Both cardiac computed tomography and cardiac magnetic resonance contribute to postprocedural evaluation of pulmonary vein isolation ablation. The present review is the second of a 2-part series where we discuss the roles of cardiac imaging in the evaluation and management of patients with atrial fibrillation, focusing on intraprocedural and postprocedural assessment, including the clinical evidence and outcomes data supporting this future applications.
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Affiliation(s)
- Raymundo A Quintana
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus (R.A.Q.)
| | - Tiffany Dong
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Ramya Vajapey
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Reza Reyaldeen
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Deborah H Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Serge Harb
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Tom Kai Ming Wang
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
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Quintana RA, Dong T, Vajapey R, Reyaldeen R, Kwon DH, Harb S, Wang TKM, Klein AL. Preprocedural Multimodality Imaging in Atrial Fibrillation. Circ Cardiovasc Imaging 2022; 15:e014386. [PMID: 36256725 DOI: 10.1161/circimaging.122.014386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with increased risk of heart failure, stroke, and death. In current medical practice, multimodality imaging is routinely used in the management of AF. Twenty-one years ago, the ACUTE trial (Assessment of Cardioversion Using Transesophageal Echocardiography) results were published, and the management of AF changed forever by incorporating transesophageal echocardiography guided cardioversion of patients in AF for the first time. Current applications of multimodality imaging in AF in 2022 include the use of transesophageal echocardiography and computed tomography before cardioversion to exclude left atrial thrombus and in left atrial appendage occlusion device implantation. Transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance are clinically used for AF ablation planning. The decision to use a particular imaging modality in AF is based on patient's characteristics, guideline recommendation, institutional preferences, expertise, and cost. In this first of 2-part review series, we discuss the preprocedural role of echocardiography, computed tomography, and cardiac magnetic resonance in the AF, with regard to their clinical applications, relevant outcomes data and unmet needs, and highlights future directions in this rapidly evolving field.
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Affiliation(s)
- Raymundo A Quintana
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (R.A.Q.)
| | - Tiffany Dong
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Ramya Vajapey
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Reza Reyaldeen
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Deborah H Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Serge Harb
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Tom Kai Ming Wang
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
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Zhang X, Hou S, Liu W, Chen W, Chen F, Ma W, Wang J, Fan Y, Wang Y, Chang D, Fu H, Cai H, Zhang Y, Hou CR, Xu Y, Zhou D, Ge J. Percutaneous Left Atrial Appendage Closure With a Novel LAA Occluder for Stroke Prevention in Atrial Fibrillation. JACC. ASIA 2022; 2:547-556. [PMID: 36518725 PMCID: PMC9743450 DOI: 10.1016/j.jacasi.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/29/2022] [Accepted: 04/25/2022] [Indexed: 01/11/2023]
Abstract
Background More than 90% of thromboses originate from the left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation (NVAF). Objectives This study was designed to investigate the safety and efficacy of LAA closure with the Leftear device (Pulse Scientific) in NVAF patients. Methods A prospective, multicenter, registry-based study was conducted in 200 NVAF patients with CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack, vascular disease, female sex) scores ≥2. The primary safety endpoint was defined as any serious adverse events. Efficacy was assessed by a primary composite endpoint of hemorrhagic or ischemic stroke, systemic embolism, and cardiac or unexplained death at 1 year of follow-up. Results The device was implanted in 196 patients, with 1-stop LAA closure combined with atrial fibrillation ablation implemented in 133 patients. The immediate success rate was 100%. There were serious adverse events in 9 patients (4.5%; 95% CI: 1.6%-7.4%), which mainly occurred in 1-stop LAA closure. All pericardial tamponades occurred in 6 patients with 1-stop LAA closure. No patient experienced a major bleeding event or acute device-related thrombus. During the 12-month follow-up period, the risk of the primary composite endpoint was 1.6% (95% CI: 0.3%-4.5%), and statistical noninferiority was achieved (the upper bound of 95% CI: 4.5% < the prespecified maximum annual incidence of 8.0%). Ischemic stroke occurred in 1 patient, 3 patients had incomplete LAA sealing, and no delayed device-related thrombus was found. Conclusions LAA closure with the novel disc-like occluder shows high procedural success, satisfactory safety, and encouraging efficacy for stroke prevention in patients with NVAF. Compared with 1-stop LAA closure, single LAA closure may be more tolerable. (A multicenter, single-arm clinical trial to evaluate the efficacy and safety of left atrial appendage system for left atrial appendage occlusion in patients with non-valvular atrial fibrillation; ChiCTR1900023035).
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Affiliation(s)
- Xiaochun Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Shanghai, People’s Republic of China
| | - Shiqiang Hou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Shanghai, People’s Republic of China
| | - Weijing Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Wei Chen
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Fadong Chen
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Wei Ma
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Jian’an Wang
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, People’s Republic of China
| | - Youqi Fan
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, People’s Republic of China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Fujian, People’s Republic of China
| | - Dong Chang
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Fujian, People’s Republic of China
| | - Hua Fu
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Heng Cai
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Yushun Zhang
- Department of Cardiology, First Affiliated Hospital of Xi 'an Jiaotong University, Shaanxi, People’s Republic of China
| | - Cody R. Hou
- College of Biological Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Address for correspondence: Dr Yawei Xu, Department of Cardiology, Shanghai Tenth People's Hospital, No. 301 Yanchang Middle Road, Shanghai 200072, People’s Republic of China.
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Shanghai, People’s Republic of China
- Dr Daxin Zhou, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, No.180 Fenglin Road, Shanghai 200032, People's Republic of China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Shanghai, People’s Republic of China
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Bregasi A, Freeman JV, Curtis JP, Akar JG, Ortiz-Leon XA, Maia JH, Higgins AY, Matthews RV, Sinusas AJ, McNamara RL, Sugeng L, Lin BA. Abnormal left atrial body stiffness is predicted by appendage size: impact of appendage occlusion on left atrial mechanics assessed by pressure-volume analysis. Am J Physiol Heart Circ Physiol 2022; 323:H559-H568. [PMID: 35960632 PMCID: PMC9576173 DOI: 10.1152/ajpheart.00083.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Atrial cardiomyopathy has been recognized as having important consequences for cardiac performance and clinical outcomes. The pathophysiological role of the left atrial (LA) appendage and the effect of percutaneous left atrial appendage occlusion (LAAO) upon LA mechanics is incompletely understood. We evaluated if changes in LA stiffness due to endocardial LAAO can be detected by LA pressure-volume (PV) analysis and whether stiffness parameters are associated with baseline characteristics. Patients undergoing percutaneous endocardial LAAO (n = 25) were studied using a novel PV analysis using near-simultaneous three-dimensional LA volume measurements by transesophageal echocardiography (TEE) and direct invasive LA pressure measurements. LA stiffness (dP/dV, change in pressure with change in volume) was calculated before and after LAAO. Overall LA stiffness significantly increased after LAAO compared with baseline (median, 0.41-0.64 mmHg/mL; P ≪ 0.001). LA body stiffness after LAAO correlated with baseline LA appendage size by indexed maximum depth (Spearman's rank correlation coefficient Rs = 0.61; P < 0.01). LA stiffness change showed an even stronger correlation with baseline LA appendage size by indexed maximum depth (Rs = 0.70; P < 0.001). We found that overall LA stiffness increases after endocardial LAAO. Baseline LA appendage size correlates with the magnitude of increase and LA body stiffness. These findings document alteration of LA mechanics after endocardial LAAO and suggest that the LA appendage modulates overall LA compliance.NEW & NOTEWORTHY Our study documents a correlation of LA appendage remodeling with the degree of chronically abnormal LA body stiffness. In addition, we found that LA appendage size was the baseline parameter that best correlated with the magnitude of a further increase in overall LA stiffness after appendage occlusion. These findings offer insights about the LA appendage and LA mechanics that are relevant to patients at risk for adverse atrial remodeling, especially candidates for LA appendage occlusion.
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Affiliation(s)
- Alda Bregasi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - James V Freeman
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Joseph G Akar
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Julia H Maia
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Angela Y Higgins
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ray V Matthews
- Division of Cardiovascular Medicine, Department of Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
- Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ben A Lin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
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Eckstein J, Renner A, Zittermann A, Fink T, Sohns C, Niehaus K, Bednarz H, Neumann JM, Piran M, Kellner U, Gummert J. Impact of left atrial appendage fibrosis on atrial fibrillation in patients following coronary bypass surgery. Clin Cardiol 2022; 45:1029-1035. [PMID: 35864729 PMCID: PMC9574744 DOI: 10.1002/clc.23884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives We aimed to assess the relationship of left atrial appendage (LAA) fibrosis with atrial fibrillation (AF) and postoperative events in patients receiving coronary artery bypass graft surgery (CABG). Background Increased atrial fibrosis has been associated with AF and worse outcome following catheter ablation. Only limited data exists focusing on the impact of LAA fibrosis on AF after CABG. Methods LAA tissue from 164 CABG‐patients was stained with Masson‐Goldner trichrome. The histological landscape was scanned and segmented into superpixels for software analysis (QuPath). A classification algorithm was extensively trained to detect fibrotic superpixels for quantification. In 43 propensity score matched pairs with AF or sinus rhythm (SR), LAA fibrosis was compared. Moreover, subgroups of mitral valve regurgitation (MR) were analyzed as follows: SR, SR + MR, AF and AF + MR. The predictive value of LAA fibrosis postoperative stroke, postoperative AF and mortality was assessed. Results Fibrotic remodeling (%) showed no significant difference for the total cohort between the SR and AF group (SR: 30.8 ± 11.4% and AF: 33.8 ± 16.0%, respectively, p = .32). However, significant fibrotic remodeling was observed for SR and AF subgroups (SR: 27.2 ± 12.2% vs. AF: 35.3 ± 13.7%; respectively, p = .049) and between SR and SR + MR subgroups (SR: 27.2 ± 12.2% vs. SR + MR: 34.9 ± 9.1%, respectively, p = .027). LAA fibrosis was not significantly associated with postoperative stroke, postoperative AF or overall mortality (all p > .05). Conclusion LAA fibrosis may contribute to an individual arrhythmia substrate for AF in patients with AF but also in those with SR and coincidence of MR. LAA fibrosis was not found to be predictive for clinical events in patients after CABG.
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Affiliation(s)
- Jan Eckstein
- Department for Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - André Renner
- Clinic for Cardiovascular and Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Cardiovascular and Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Karsten Niehaus
- Proteome and Metabolome Research, Center for Biotechnology (CeBiTec), Faculty of Biology, Bielefeld University, NRW, Bielefeld, Germany
| | - Hanna Bednarz
- Proteome and Metabolome Research, Center for Biotechnology (CeBiTec), Faculty of Biology, Bielefeld University, NRW, Bielefeld, Germany.,Medical School OWL, AG1: Sustainable Environmental Health Sciences, Bielefeld University, NRW, Bielefeld, Germany
| | - Judith Martha Neumann
- Proteome and Metabolome Research, Center for Biotechnology (CeBiTec), Faculty of Biology, Bielefeld University, NRW, Bielefeld, Germany
| | - Misagh Piran
- Department for Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Udo Kellner
- Institute for Pathology and Molecular Pathology, Johannes Wesling Klinikum, Ruhr-University Bochum, Minden, Germany
| | - Jan Gummert
- Clinic for Cardiovascular and Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
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Machino-Ohtsuka T, Nakagawa D, Albakaa NK, Nakatsukasa T, Kawamatsu N, Sato K, Yamamoto M, Yamasaki H, Ishizu T, Ieda M. Clinical Characteristics of Non-Valvular Atrial Fibrillation Patients With a Large Left Atrial Appendage Ostium-Limiting Percutaneous Closure. Circ J 2022; 86:1263-1272. [PMID: 35786689 DOI: 10.1253/circj.cj-22-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The left atrial appendage (LAA) is a therapeutic target for preventing cardioembolic stroke in patients with non-valvular atrial fibrillation (NVAF). A large LAA ostium limits percutaneous LAA closure. This study investigated the characteristics and factors associated with a large LAA ostium in Japanese patients with NVAF.Methods and Results: In 1,102 NVAF patients, the maximum LAA diameter was measured using transesophageal echocardiography (TEE). A large LAA ostium was defined by a maximum diameter of >30 mm. Forty-four participants underwent repeated TEEs, and changes in LAA size under lasting AF were assessed. A large LAA ostium was observed in 3.1% of all participants and 8.9% of patients with long-standing persistent AF (LSAF). The large LAA group had greater CHA2DS2-VASc (P=0.024) and HAS-BLED scores (P=0.046) and a higher prevalence of LAA thrombus (P=0.004) than did the normal LAA group. LSAF, moderate or severe mitral regurgitation, left atrial volume ≥42 mL/m2, E/E' ratio ≥9.5, and left ventricular mass ≥85 mg/m2were independently associated with a large LAA ostium (P<0.001, P<0.001, P=0.009, P=0.009, and P=0.032, respectively). In 44 patients with lasting AF, the LAA ostial diameter increased over time (P<0.001). CONCLUSIONS NVAF patients with a large LAA ostium may have a higher risk of stroke and bleeding. LSAF and factors leading to LA overload may be closely associated with LAA ostial dilatation and can promote it.
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Affiliation(s)
| | - Daishi Nakagawa
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Noor K Albakaa
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Naoto Kawamatsu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kimi Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Tomoko Ishizu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
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24
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Implantation of Watchman FLX for Patients with Difficult Left Atrial Appendage Anatomy: A Case-Based Discussion. Curr Probl Cardiol 2022; 47:101266. [DOI: 10.1016/j.cpcardiol.2022.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
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25
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Pour-Ghaz I, Heckle MR, Maturana M, Seitz MP, Zare P, Khouzam RN, Kabra R. Percutaneous Left Atrial Appendage Closure: Review of Anatomy, Imaging, and Outcomes. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022. [DOI: 10.1007/s11936-022-00958-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Hamadanchi A, Ijuin S, Haertel F, Bekfani T, Westphal J, Franz M, Moebius-Winkler S, Schulze PC. A Novel Echocardiographic-Based Classification for the Prediction of Peri-Device Leakage Following Left Atrial Appendage Occluder Implantation. J Clin Med 2022; 11:jcm11041059. [PMID: 35207334 PMCID: PMC8877112 DOI: 10.3390/jcm11041059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/21/2022] [Accepted: 02/12/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: The assessment of residual peri-device leakages (PDL) after left atrial appendage occlusion (LAAO) remains crucial for post-procedural management. Our study aimed to verify a novel echocardiographic classification for the prediction of PDL. (2) Methods: Echocardiographic data of 72 patients who underwent percutaneous LAAO were evaluated. All echo images were analyzed by two independent investigators using standard analysis software (Image-Arena IA-4.6.4.44 by TomTec®, Munich, Germany). A total number of 127 studies was evaluated. Forty-four patients had baseline studies, at 45 days and at 6 months post-implantation. We propose a morphological classification of LAA devices based on the amount of echodensity inside the devices into three types: type A showing complete homogenous thrombosis, type B incompletely thrombosed device with inhomogeneous echo-free space <50% of device, and type C with partially thrombosed device in which the echo free space was >50% of device in various planes, which we called the “ice-cream cone” sign. Each type was matched to the degree of PDL and clinical outcome parameters. (3) Results: Patients with type C had the highest percentage of PDL at 45 days follow-up (type A: 24%, type B: 31%, type C 100% PDL, p < 0.001) and at 6 months follow-up (type A: 7%, type B: 33%, type C 100% PDL, p < 0.001). Notably, device size in patients with PDL was larger than that in patients without PDL at 6 months follow-up (25.6 ± 3.5 mm vs. 28.7 ± 3.4 mm, p = 0.004). Device size in patients with type C appearance was the largest of the three types (type A: 25.9 ± 3.6 mm, type B: 25.8 ± 3.4 mm, type C 29.8 ± 3.0 mm, type A vs. C; p = 0.019; type B vs. C, p = 0.007). (4) Conclusions: In conclusion, PDL are common post-LAAO, and their frequency is underestimated and under-recognized. PDL are much more common in patients with larger LAA ostial sizes and likely lower longitudinal compression. Type C appearance of the LAAO devices (“ice-cream cone sign”) has a high positive predictive value for PDL. Further studies are needed for better delineation of the clinical importance of this proposed classification.
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Affiliation(s)
- Ali Hamadanchi
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
- Correspondence: ; Tel.: +49-3641-9-32-46-45; Fax: +49-3641-9-32-41-02
| | - Shun Ijuin
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
- Department of Cardiology, National Hospital Organization Kagoshima Medical Center, Kagoshima 892-0853, Japan
| | - Franz Haertel
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
| | - Tarek Bekfani
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Magdeburg, Otto von Guericke-University, 39120 Magdeburg, Germany;
| | - Julian Westphal
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
| | - Marcus Franz
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
| | - Sven Moebius-Winkler
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
| | - P. Christian Schulze
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
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Kim WD, Cho I, Kim YD, Cha MJ, Kim SW, Choi Y, Shin SY. Improving Left Atrial Appendage Occlusion Device Size Determination by Three-Dimensional Printing-Based Preprocedural Simulation. Front Cardiovasc Med 2022; 9:830062. [PMID: 35252401 PMCID: PMC8889006 DOI: 10.3389/fcvm.2022.830062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/18/2022] [Indexed: 01/01/2023] Open
Abstract
Background The two-dimensional (2D)-based left atrial appendage (LAA) occluder (LAAO) size determination by using transesophageal echocardiography (TEE) is limited by the structural complexity and wide anatomical variation of the LAA. Objective This study aimed to assess the accuracy of the LAAO size determination by implantation simulation by using a three-dimensional (3D)-printed model compared with the conventional method based on TEE. Methods We retrospectively reviewed patients with anatomically and physiologically properly implanted the Amplatzer Cardiac Plug and Amulet LAAO devices between January 2014 and December 2018 by using the final size of the implanted devices as a standard for size prediction accuracy. The use of 3D-printed model simulations in device sizing was compared with the conventional TEE-based method. Results A total of 28 cases with the percutaneous LAA occlusion were reviewed. There was a minimal difference [−0.11 mm; 95% CI (−0.93, 0.72 mm); P = 0.359] between CT-based reconstructed 3D images and 3D-printed left atrium (LA) models. Device size prediction based on TEE measurements showed poor agreement (32.1%), with a mean difference of 2.3 ± 3.2 mm [95% CI (−4.4, 9.0)]. The LAAO sizing by implantation simulation with 3D-printed models showed excellent correlation with the actually implanted LAAO size (r = 0.927; bias = 0.7 ± 2.5). The agreement between the 3D-printed and the implanted size was 67.9%, with a mean difference of 0.6 mm [95% CI (−1.9, 3.2)]. Conclusion The use of 3D-printed LA models in the LAAO size determination showed improvement in comparison with conventional 2D TEE method.
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Affiliation(s)
- William D. Kim
- College of Medicine, Chung-Ang University, Seoul, South Korea
| | - Iksung Cho
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Doo Kim
- Department of Mechanical Engineering, Graduate School, Chung-Ang University, Seoul, South Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Seoul, South Korea
| | - Sang-Wook Kim
- Division of Cardiology, Chung-Ang University Hospital, Seoul, South Korea
- Heart Research Institute, Chung-Ang University Hospital, Seoul, South Korea
| | - Young Choi
- Department of Mechanical Engineering, Graduate School, Chung-Ang University, Seoul, South Korea
| | - Seung Yong Shin
- Division of Cardiology, Chung-Ang University Hospital, Seoul, South Korea
- *Correspondence: Seung Yong Shin
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Hahn RT, Saric M, Faletra FF, Garg R, Gillam LD, Horton K, Khalique OK, Little SH, Mackensen GB, Oh J, Quader N, Safi L, Scalia GM, Lang RM. Recommended Standards for the Performance of Transesophageal Echocardiographic Screening for Structural Heart Intervention: From the American Society of Echocardiography. J Am Soc Echocardiogr 2022; 35:1-76. [PMID: 34280494 DOI: 10.1016/j.echo.2021.07.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rebecca T Hahn
- Columbia University Irving College of Medicine, New York, New York
| | - Muhamed Saric
- New York University Langone Health, New York, New York
| | | | - Ruchira Garg
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Omar K Khalique
- Columbia University Irving College of Medicine, New York, New York
| | - Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | - Jae Oh
- Mayo Clinic, Rochester, Minnesota
| | | | - Lucy Safi
- Hackensack University Medical Center, Hackensack, New Jersey
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29
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Branzoli S, Guarracini F, Marini M, D’Onghia G, Penzo D, Piffer S, Peterlana D, Graffigna A, Gulizia MM, Gelsomino S, La Meir M. Heart Team for Left Atrial Appendage Occlusion: A Patient-Tailored Approach. J Clin Med 2021; 11:176. [PMID: 35011916 PMCID: PMC8745334 DOI: 10.3390/jcm11010176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Left atrial appendage occlusion (LAAO) is an accepted therapeutic option for stroke prevention; however, the ideal technique and device have not yet been identified. In this study we evaluate the potential role of a heart team approach for patients contraindicated for oral anticoagulants and indicated for left atrial appendage closure, to minimize risk and optimize benefit in a patient-centered decision-making process. METHODS Forty patients were evaluated by the heart team for appendage occlusion. Variables considered were CHA2DS2VASc, HASBLED, documented blood transfusions, comorbidities, event forcing anticoagulant interruption, past medical history, anatomy of the left atrial appendage, and patient quality of life. Twenty patients had their appendage occluded percutaneously (65% male, mean age 72.3 ± 7.5, mean CHA2DS2VASc 4.2 ± 1.5, mean HASBLED 3.5 ± 1.1). The other twenty underwent thoracoscopic occlusion (65% male, mean age of 74.9 ± 8, mean CHA2DS2VASc 6.0 ± 1.5, HASBLED mean 5.4 ± 1.4). Percutaneous patients were on dual antiplatelet therapy for the first three months and aspirin thereafter, whereas the others received no anticoagulant/antiplatelet therapy from the day of surgery. Follow up included TEE, CT scan, and periodical clinical evaluation. RESULTS Mean duration of procedures and hospital stay were comparable. All patients had complete exclusion of the appendage; at a mean follow up of 33.1 ± 14.1 months, no neurological or hemorrhagic events were reported. CONCLUSIONS A heart team approach may improve the decision-making process for stroke and hemorrhage prevention, where LAAO is a therapeutic option. Percutaneous and thoracoscopic appendage occlusion seem to be comparably safe and effective. An epicardial LAAO could be advisable in patients for whom the risk of bleeding is estimated as being too high for post-procedural antiplatelet therapy.
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Affiliation(s)
- Stefano Branzoli
- Department of Cardiac Surgery, UZ Brussel, Av. du Laerbeek 101, 1090 Brussels, Belgium; (S.G.); (M.L.M.)
- Cardiac Surgery Unit, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, Italy;
| | - Fabrizio Guarracini
- Department of Cardiology, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, Italy; (F.G.); (M.M.); (G.D.)
| | - Massimiliano Marini
- Department of Cardiology, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, Italy; (F.G.); (M.M.); (G.D.)
| | - Giovanni D’Onghia
- Department of Cardiology, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, Italy; (F.G.); (M.M.); (G.D.)
| | - Daniele Penzo
- Department of Anesthesia, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, Italy;
| | - Silvio Piffer
- Neurology Unit, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, Italy;
| | - Dimitri Peterlana
- Division of General Internal Medicine Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, Italy;
| | - Angelo Graffigna
- Cardiac Surgery Unit, Santa Chiara Hospital, Largo Medaglie d’oro, 38122 Trento, Italy;
| | - Michele Massimo Gulizia
- Cardiology Complex Unit, Garibaldi Nesima Hospital, 95122 Catania, Italy;
- Heart Care Foundation, 50121 Florence, Italy
| | - Sandro Gelsomino
- Department of Cardiac Surgery, UZ Brussel, Av. du Laerbeek 101, 1090 Brussels, Belgium; (S.G.); (M.L.M.)
| | - Mark La Meir
- Department of Cardiac Surgery, UZ Brussel, Av. du Laerbeek 101, 1090 Brussels, Belgium; (S.G.); (M.L.M.)
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Pre-procedural determination of device size in left atrial appendage occlusion using three-dimensional cardiac computed tomography. Sci Rep 2021; 11:24107. [PMID: 34916575 PMCID: PMC8677741 DOI: 10.1038/s41598-021-03537-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/06/2021] [Indexed: 12/31/2022] Open
Abstract
The complex structure of the left atrial appendage (LAA) brings limitations to the two-dimensional-based LAA occlusion (LAAO) size prediction system using transesophageal echocardiography. The LAA anatomy can be evaluated more precisely using three-dimensional images from cardiac computed tomography (CT); however, there is lack of data regarding which parameter to choose from CT-based images during pre-procedural planning of LAAO. We aimed to assess the accuracy of measurements derived from cardiac CT images for selecting LAAO devices. We retrospectively reviewed 62 patients with Amplatzer Cardiac Plug and Amulet LAAO devices who underwent implantation from 2017 to 2020. The minimal, maximal, average, area-derived, and perimeter-derived diameters of the LAA landing zone were measured using CT-based images. Predicted device sizes using sizing charts were compared with actual successfully implanted device sizes. The mean size of implanted devices was 27.1 ± 3.7 mm. The perimeter-derived diameter predicted device size most accurately (mean error = − 0.8 ± 2.4 mm). All other parameters showed significantly larger error (mean error; minimal diameter = − 4.9 ± 3.3 mm, maximal diameter = 1.0 ± 2.9 mm, average diameter = − 1.6 ± 2.6 mm, area-derived diameter = − 2.0 ± 2.6 mm) than the perimeter-derived diameter (all p for difference < 0.05). The error for other parameters were larger in cases with more eccentrically-shaped landing zones, while the perimeter-derived diameter had minor error regardless of eccentricity. When oversizing was used, all parameters showed significant disagreement. The perimeter-derived diameter on cardiac CT images provided the most accurate estimation of LAAO device size regardless of landing zone eccentricity. Oversizing was unnecessary when using cardiac CT to predict an accurate LAAO size.
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Kemi Y, Yamashita E, Fujiwara T, Kario K, Sasaki T, Minami K, Miki Y, Goto K, Take Y, Nakamura K, Naito S. The prevalence and characteristics of candidates for percutaneous left atrial appendage occlusion using a WATCHMAN device among patients who underwent atrial fibrillation ablation in a Japanese population. J Echocardiogr 2021; 19:243-249. [PMID: 34296416 DOI: 10.1007/s12574-021-00538-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/22/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Percutaneous left atrial appendage occlusion (LAAO) using a WATCHMAN device could be a treatment option for patients with non-valvular atrial fibrillation (AF) with thromboembolic and bleeding risk. We sought to determine the prevalence and characteristics of patients with AF ablation who are potential candidates for WATCHMAN implantation in a Japanese population. METHODS We enrolled 2443 consecutive patients who had previously undergone AF ablation and transesophageal echocardiography (TEE). We assessed their clinical characteristics and measured their LAA orifice diameter and depth retrospectively using the obtained TEE images. We defined patients who met both anatomical criteria (LAA orifice max diameter: 17-31 mm and LAA max depth > LAA orifice max diameter) and clinical criteria (CHA2DS2-VASc score ≥ 2 and HAS-BLED score ≥ 3) as LAAO candidates. RESULTS Among the 2443 enrolled patients, 361 (15%) met the clinical criteria, and 1928 (79%) met the anatomical criteria. Thus 12% (293/2443) of the total patient group met the criteria of LAAO candidates. LAAO candidates showed larger left atrial (LA) volume (77.6 ± 30.1 vs. 67.7 ± 29.1 mL, P < 0.001), larger LAA orifice diameter (22.5 ± 3.2 vs. 22.0 ± 4.3 mm, P = 0.026), and larger LAA depth (28.9 ± 4.6 vs. 27.0 ± 4.8 mm, P < 0.001). LAAO candidates made up only 23% of patients with CHA2DS2-VASc score ≥ 2 (N = 1295), whereas 78% of patients with a HAS-BLED score ≥ 3 (N = 378) were LAAO candidates. CONCLUSION Twelve percent of patients who underwent AF ablation were potential candidates for LAAO using a WATCHMAN device in this Japanese population. It is imperative to evaluate bleeding risk when considering the indications for LAAO.
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Affiliation(s)
- Yuta Kemi
- Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi, Maebashi, Gunma, 371-0004, Japan. .,Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
| | - Eiji Yamashita
- Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi, Maebashi, Gunma, 371-0004, Japan.,Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Takeshi Fujiwara
- Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Kazuomi Kario
- Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Takehito Sasaki
- Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi, Maebashi, Gunma, 371-0004, Japan
| | - Kentaro Minami
- Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi, Maebashi, Gunma, 371-0004, Japan
| | - Yuko Miki
- Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi, Maebashi, Gunma, 371-0004, Japan
| | - Koji Goto
- Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi, Maebashi, Gunma, 371-0004, Japan
| | - Yutaka Take
- Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi, Maebashi, Gunma, 371-0004, Japan
| | - Kohki Nakamura
- Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi, Maebashi, Gunma, 371-0004, Japan
| | - Shigeto Naito
- Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi, Maebashi, Gunma, 371-0004, Japan
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One year outcome and analysis of peri-device leak of left atrial appendage occlusion devices. J Interv Card Electrophysiol 2021; 64:27-34. [PMID: 34002319 DOI: 10.1007/s10840-021-01002-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The prevalence of peri-device leak (PDL) of left atrial appendage occlusion (LAAO) devices has been previously reported. However, there have been only few data that compared different existing devices. The aim of this study was to assess the incidence of PDL with both devices WATCHMAN®, Boston Scientific and AMPLATZER Amulet®, Abbott Laboratories and to evaluate the clinical outcome at 12 months. METHODS Consecutive patients who underwent LAAO between January 2018 and 2020 were randomly assigned to either WATCHMAN or AMPLATZER Amulet implantation based on a systematic 2-week alternation between both devices. LAA measurements were assessed using cardiac computed tomography angiography (CCTA) prior to and transesophageal echocardiography (TEE) during the procedure. At 8 weeks post-LAAO, patients underwent TEE and/or CCTA to identify the presence of PDL and/or device-related complications. Patients were then followed for 12 months to identify major adverse cardiovascular/embolic events. RESULTS The cohort consisted of 51 patients (25 WATCHMAN, 26 AMPLATZER Amulet; mean age 76 ± 7 years; male gender 76%). Both groups were identically matched for demographics, comorbidities, and indication for LAAO. There were 19 patients who had PDL (13 WATCHMAN vs. 6 AMPLATZER Amulet, P-value = 0.033). Of them, 8 (15%) patients had significant PDL (7 WATCHMAN vs. 1 AMPLATZER Amulet, P-value = 0.018). On CCTA, the landing zone maximal diameter of the AMPLATZER Amulet device had the strongest correlation with the final deployed device size (Spearman's rho 0.92, P-value < 0.0001). In the multivariate analysis, male gender and device type were independent predictors of any PDL (P-values 0.016 and 0.031, respectively). On a mean follow-up of 12 months, the total number of events was more prevalent in the WATCHMAN group (P-value 0.008), but the incidence of cardio-embolic events reached borderline significance (16% vs. 0%, P-value = 0.051). CONCLUSIONS Among patients who underwent LAAO, almost 15% had significant PDL with the majority belonging to the WATCHMAN group. Still, larger studies are warranted to evaluate its effectiveness in stroke prevention.
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Joury A, Abelhad N, Kelly J, Benn F, Englert JA. Large Cystic Intracardiac Mass Overlying Left Atrial Appendage Occlusion Device: A Case Report and Literature Review. CASE 2021; 5:12-15. [PMID: 33644507 PMCID: PMC7887612 DOI: 10.1016/j.case.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The Watchman device is a possibility for patients with an elevated risk of stroke or bleeding. Device-related infection is extremely uncommon. Patient screening and selection prior to Watchman implantation are of vital importance. Device-related infection is related to peri-implantation bacteremia or inadequate sterility.
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Sharma A, Bertog S, Tholakanahalli V, Mbai M, Chandrashekhar YS. 4D Intracardiac Echocardiography-Guided LA Appendage Closure Under Conscious Sedation: Initial Experience and Procedural Technique. JACC Cardiovasc Imaging 2020; 14:2254-2259. [PMID: 33221230 DOI: 10.1016/j.jcmg.2020.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Alok Sharma
- Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota, USA.
| | - Stefan Bertog
- Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota, USA
| | - Venkat Tholakanahalli
- Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota, USA
| | - Mackenzie Mbai
- Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota, USA
| | - Y S Chandrashekhar
- Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota, USA
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Agarwal S, Pouyan A, Hreibe H. Transesophageal Echocardiographic Guidance in the Implantation of a Watchman Left Atrial Appendage Closure Device. A A Pract 2020; 14:e01309. [PMID: 32985846 DOI: 10.1213/xaa.0000000000001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Shvetank Agarwal
- From the Department of Anesthesiology and Perioperative Medicine
| | - Arman Pouyan
- Division of Cardiology, Augusta University, Augusta, Georgia
| | - Haitham Hreibe
- Division of Cardiology, Augusta University, Augusta, Georgia
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36
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Kaafarani M, Saw J, Daniels M, Song T, Rollet M, Kesinovic S, Lamorgese T, Kubiak K, Qi Z, Pantelic M, O'Neill W, Wang DD. Role of CT imaging in left atrial appendage occlusion for the WATCHMAN™ device. Cardiovasc Diagn Ther 2020; 10:45-58. [PMID: 32175227 DOI: 10.21037/cdt.2019.12.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Computed tomography (CT) plays a key role in the peri-procedural planning of left atrial appendage occlusion (LAAO) device placement and post-procedural evaluation. The geometric variability of the interatrial septum, left atrium, and the left atrial appendage morphology can be fully visualized and intuitively appreciated through CT-derived, patient-specific 3D model unique to each individual's anatomy. This review further defines the strengths and limitations of CT peri-procedural imaging in the planning of LAAO.
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Affiliation(s)
- Mirna Kaafarani
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, British Columbia, Canada
| | - Matthew Daniels
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Thomas Song
- Department of Cardiothoracic Radiology, Henry Ford Health System, Detroit, Michigan
| | - Marianne Rollet
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Sanel Kesinovic
- Watchman, Interventional Cardiology Group, Boston Scientific, Marlborough, MA, USA
| | - Tony Lamorgese
- Watchman, Interventional Cardiology Group, Boston Scientific, Marlborough, MA, USA
| | - Kati Kubiak
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Zhihua Qi
- Department of Cardiothoracic Radiology, Henry Ford Health System, Detroit, Michigan
| | - Milan Pantelic
- Department of Cardiothoracic Radiology, Henry Ford Health System, Detroit, Michigan
| | - William O'Neill
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
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Spilias N, Kochar A, Patel J, Saliba W, Kapadia S. Percutaneous Retrieval of a Watchman Device from the Left Ventricle Using a Transarterial Approach. JACC Case Rep 2019; 1:876-883. [PMID: 34316950 PMCID: PMC8288985 DOI: 10.1016/j.jaccas.2019.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Nikolaos Spilias
- Address for correspondence: Dr. Nikolaos Spilias, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-3, Cleveland, Ohio 44195.
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Ramchand J, Harb SC, Miyasaka R, Kanj M, Saliba W, Jaber WA. Imaging for Percutaneous Left Atrial Appendage Closure: A Contemporary Review. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1643957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Jay Ramchand
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serge C. Harb
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rhonda Miyasaka
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wael A. Jaber
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Vainrib AF, Bamira D, Aizer A, Chinitz LA, Loulmet D, Benenstein RJ, Saric M. Photorealistic imaging of left atrial appendage occlusion/exclusion. Echocardiography 2019; 36:1601-1604. [PMID: 31385344 DOI: 10.1111/echo.14438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/27/2019] [Accepted: 06/30/2019] [Indexed: 11/30/2022] Open
Abstract
Recent improvements in 3D TEE post processing rendering techniques referred to as TrueVue (Philips Medical Systems, Andover, MA, USA). It allows for novel photorealistic imaging of cardiac structures including left atrial appendage (LAA) and its closure devices. Here we present TrueVue images of the LAA prior to and after LAA exclusion/occlusion using various percutaneous and surgical techniques. TrueVue may improve delineation of LAA anatomy prior to occlusion as well as visualization of occluder device position within the LAA.
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Affiliation(s)
- Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Didier Loulmet
- Division of Cardiothoracic Surgery, New York University Langone Health, New York City, New York
| | - Ricardo J Benenstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York City, New York
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40
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Altszuler D, Vainrib AF, Bamira DG, Benenstein RJ, Aizer A, Chinitz LA, Saric M. Left Atrial Occlusion Device Implantation: the Role of the Echocardiographer. Curr Cardiol Rep 2019; 21:66. [PMID: 31183616 DOI: 10.1007/s11886-019-1151-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Atrial fibrillation is the most common arrhythmia worldwide and is a major risk factor for embolic stroke. For patients with atrial fibrillation who are unable to tolerate systemic anticoagulation, left atrial appendage (LAA) occlusion has been shown to mitigate stroke risk. In this article, we describe the vital role of the echocardiographer in intraprocedural guidance of percutaneous LAA occlusion procedures as well as in the pre- and post-procedure assessment of these patients. RECENT FINDINGS A few percutaneously delivered devices for LAA exclusion from the systemic circulation are available in contemporary practice. These devices employ an either exclusive endocardial LAA occlusion approach, such as the Watchman (Boston Scientific, Maple Grove, MN) and Amulet (St. Jude Medical, Minneapolis, MN), or both an endocardial and pericardial (epicardial) approach such as the Lariat procedure (SentreHEART, Palo Alto, CA). Two- and three-dimension transesophageal echocardiography is critical for patient selection, procedure planning, procedural guidance, and ensuring satisfactory immediate as well as long-term LAA occlusion/exclusion efficacy. This review will provide an overview of the role of the echocardiographer in all aspects of LAA occlusion/exclusion procedures for the most commonly used commercially available devices in current practice.
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Affiliation(s)
- David Altszuler
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Daniel G Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Ricardo J Benenstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA.
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41
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Affiliation(s)
- Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Weill Cornell Medicine, Houston, Texas.
| | - Muhamed Saric
- Langone Health, New York University, New York, New York
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Billick K. Structural Heart Imaging: Focus on Left Atrial Appendage Occlusion. J Am Soc Echocardiogr 2019; 32:A20. [PMID: 31171109 DOI: 10.1016/j.echo.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vainrib AF, Bamira D, Benenstein RJ, Aizer A, Chinitz LA, Saric M. Echocardiographic Guidance of the Novel WaveCrest Left Atrial Appendage Occlusion Device. ACTA ACUST UNITED AC 2018; 2:297-300. [PMID: 30582095 PMCID: PMC6302034 DOI: 10.1016/j.case.2018.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The WaveCrest device is a novel LAA occluder with unique features. Two-dimensional and 3D TEE and fluoroscopy are essential for successful implantation. Air between layers of WaveCrest ePTFE fabric may obscure visualization on TEE.
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Affiliation(s)
- Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Ricardo J Benenstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
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44
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Deegan R, Ellis CR, Bennett JM. The Left Atrial Appendage, Including LAA Occlusion Devices Line Watchman, Amulet, and Lariat. Semin Cardiothorac Vasc Anesth 2018; 23:70-87. [PMID: 30020024 DOI: 10.1177/1089253218789159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Atrial fibrillation is a very common arrhythmia whose prevalence is expected to increase significantly as the population ages. The associated stroke risk is a major cause of morbidity and mortality. Stroke prevention by anticoagulation carries its own risks, leading to the search for alternative strategies. Multiple techniques have been developed to exclude the left atrial appendage (the main source of thromboembolism in atrial fibrillation) from the circulation. Such techniques offer the hope of stroke prevention without the risks of anticoagulation. This article describes the percutaneous approaches being currently performed in the United States. Particular emphasis is placed on the use of transesophageal echocardiography to guide these procedures.
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Affiliation(s)
- Robert Deegan
- 1 Vanderbilt University Medical Center, Nashville, TN, USA
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45
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Subramaniam K, Ibarra A, Boisen ML. Echocardiographic Guidance of AMPLATZER Amulet Left Atrial Appendage Occlusion Device Placement. Semin Cardiothorac Vasc Anesth 2018; 23:248-255. [DOI: 10.1177/1089253218758463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this report, we provided details of periprocedural echocardiographic guidance for patients undergoing Amplatzer-Amulet device left atrial closure. Familiarity with left atrial appendage (LAA) occlusion devices and the required left atrial examination and measurements are key before device placement. Device placement is assisted by transesophageal echocardiography (TEE) and fluoroscopy, but TEE will be the main guide for patients with renal insufficiency in whom contrast dye use needs to be minimal. TEE is also used to confirm LAA occlusion with the device and finally detect complications throughout the procedure and into the postoperative period.
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