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Danielli F, Berti F, Fanni BM, Gasparotti E, Celi S, Pennati G, Petrini L. Left atrial appendage occlusion: On the need of a numerical model to simulate the implant procedure. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3814. [PMID: 38504482 DOI: 10.1002/cnm.3814] [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: 10/13/2023] [Revised: 01/23/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Abstract
Left atrial appendage occlusion (LAAO) is a percutaneous procedure to prevent thromboembolism in patients affected by atrial fibrillation. Despite its demonstrated efficacy, the LAA morphological complexity hinders the procedure, resulting in postprocedural drawbacks (device-related thrombus and peri-device leakage). Local anatomical features may cause difficulties in the device's positioning and affect the effectiveness of the device's implant. The current work proposes a detailed FE model of the LAAO useful to investigate implant scenarios and derive clinical indications. A high-fidelity model of the Watchman FLX device and simplified parametric conduits mimicking the zone of the LAA where the device is deployed were developed. Device-conduit interactions were evaluated by looking at clinical indicators such as device-wall gap, possible cause of leakage, and device protrusion. As expected, the positioning of the crimped device before the deployment was found to significantly affect the implant outcomes: clinician's choices can be improved if FE models are used to optimize the pre-operative planning. Remarkably, also the wall mechanical stiffness plays an important role. However, this parameter value is unknown for a specific LAA, a crucial point that must be correctly defined for developing an accurate FE model. Finally, numerical simulations outlined how the device's configuration on which the clinician relies to assess the implant success (i.e., the deployed configuration with the device still attached to the catheter) may differ from the actual final device's configuration, relevant for achieving a safe intervention.
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Affiliation(s)
- Francesca Danielli
- LaBS - Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Francesca Berti
- LaBS - Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | | | | | - Simona Celi
- BioCardioLab, Fondazione Toscana G. Monasterio, Massa, Italy
| | - Giancarlo Pennati
- LaBS - Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Milan, Italy
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Mill J, Harrison J, Saiz-Vivo M, Albors C, Morales X, Olivares AL, Iriart X, Cochet H, Noailly J, Sermesant M, Camara O. The role of the pulmonary veins on left atrial flow patterns and thrombus formation. Sci Rep 2024; 14:5860. [PMID: 38467726 DOI: 10.1038/s41598-024-56658-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
Atrial fibrillation (AF) is the most common human arrhythmia, forming thrombi mostly in the left atrial appendage (LAA). However, the relation between LAA morphology, blood patterns and clot formation is not yet fully understood. Furthermore, the impact of anatomical structures like the pulmonary veins (PVs) have not been thoroughly studied due to data acquisition difficulties. In-silico studies with flow simulations provide a detailed analysis of blood flow patterns under different boundary conditions, but a limited number of cases have been reported in the literature. To address these gaps, we investigated the influence of PVs on LA blood flow patterns and thrombus formation risk through computational fluid dynamics simulations conducted on a sizeable cohort of 130 patients, establishing the largest cohort of patient-specific LA fluid simulations reported to date. The investigation encompassed an in-depth analysis of several parameters, including pulmonary vein orientation (e.g., angles) and configuration (e.g., number), LAA and LA volumes as well as their ratio, flow, and mass-less particles. Our findings highlight the total number of particles within the LAA as a key parameter for distinguishing between the thrombus and non-thrombus groups. Moreover, the angles between the different PVs play an important role to determine the flow going inside the LAA and consequently the risk of thrombus formation. The alignment between the LAA and the main direction of the left superior pulmonary vein, or the position of the right pulmonary vein when it exhibits greater inclination, had an impact to distinguish the control group vs. the thrombus group. These insights shed light on the intricate relationship between PV configuration, LAA morphology, and thrombus formation, underscoring the importance of comprehensive blood flow pattern analyses.
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Affiliation(s)
- Jordi Mill
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain.
| | - Josquin Harrison
- Inria, Université Côte d'Azur, Epione team, 06902, Sophia Antipolis, France
| | - Marta Saiz-Vivo
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Carlos Albors
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Xabier Morales
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Andy L Olivares
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Xavier Iriart
- IHU Liryc, CHU Bordeaux, Université Bordeaux, Inserm, 33600, Pessac, France
- Bordeaux University Hospital, 33600, Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, CHU Bordeaux, Université Bordeaux, Inserm, 33600, Pessac, France
- Bordeaux University Hospital, 33600, Bordeaux, France
| | - Jerome Noailly
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Maxime Sermesant
- Inria, Université Côte d'Azur, Epione team, 06902, Sophia Antipolis, France
| | - Oscar Camara
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
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Alkhouli M. Navigating the complexities of antithrombotic therapy after LAAO. EUROINTERVENTION 2024; 20:e276-e277. [PMID: 38436371 PMCID: PMC10905190 DOI: 10.4244/eij-e-24-00001] [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: 03/05/2024]
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Basabe E, De La Flor JC, López de la Manzanara V, Nombela-Franco L, Narváez-Mejía C, Cruzado L, Villa D, Zamora R, Tapia M, Sastre MÁ, López Soberón E, Herrero Calvo JA, Suárez A, Martí Sánchez D. Percutaneous Left Atrial Appendage Closure in Patients with Non-Valvular Atrial Fibrillation and End-Stage Renal Disease on Hemodialysis: A Case Series. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:231. [PMID: 38399519 PMCID: PMC10890059 DOI: 10.3390/medicina60020231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Non-valvular atrial fibrillation (NVAF) is the most common cardiac arrhythmia in the general population, and its prevalence increases among patients with chronic kidney disease (CKD) undergoing hemodialysis. This population presents high risk of both hemorrhagic and thrombotic events, with little evidence regarding the use of oral anticoagulation treatment (OAT) and multiple complications arising from it; however, stroke prevention with percutaneous left atrial appendage closure (LAAC) is an alternative to be considered. We retrospectively describe the safety and efficacy of percutaneous LAAC in eight patients with NVAF and CKD on hemodialysis during a 12-month follow-up. The mean age was 78.8 years (range 64-86; SD ± 6.7), and seven patients were male. The mean CHA2DS2-VASC and HAS-BLED scores were high, 4.8 (SD ± 1.5) and 3.8 (SD ± 1.3), respectively. Seventy-five percent of the patients were referred for this intervention due to a history of major bleeding, with gastrointestinal bleeding being the most common type, while the remaining twenty-five percent of the patients were referred because of a high risk of bleeding. The percutaneous LAAC procedure was successfully completed in 100% of the patients, with complete exclusion of the appendage without complications or leaks exceeding 5 mm. There was one death not related to the procedure four days after the intervention. Among the other seven patients, no deaths, cardioembolic events or major bleeding were reported during the follow-up period. In our sample, percutaneous LAAC appears to be a safe and effective alternative to anticoagulation in patients with NVAF and CKD on hemodialysis.
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Affiliation(s)
- Elena Basabe
- Department of Cardiology, Hospital Central Defense Gómez Ulla, 28047 Madrid, Spain; (M.T.); (M.Á.S.); (E.L.S.); (A.S.); (D.M.S.)
| | - José C. De La Flor
- Department of Nephrology, Hospital Central Defense Gómez Ulla, 28047 Madrid, Spain;
| | | | | | - Carlos Narváez-Mejía
- Department of Nephrology, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain;
| | - Leónidas Cruzado
- Department of Nephrology, Hospital General Elche, 03203 Elche, Spain;
| | - Daniel Villa
- Department of Nephrology, Clínica Universidad de Navarra, 31008 Navarra, Spain;
| | - Rocío Zamora
- Department of Nephrology, Hospital Universitario General Villalba, 28400 Madrid, Spain;
| | - Manuel Tapia
- Department of Cardiology, Hospital Central Defense Gómez Ulla, 28047 Madrid, Spain; (M.T.); (M.Á.S.); (E.L.S.); (A.S.); (D.M.S.)
| | - Miguel Ángel Sastre
- Department of Cardiology, Hospital Central Defense Gómez Ulla, 28047 Madrid, Spain; (M.T.); (M.Á.S.); (E.L.S.); (A.S.); (D.M.S.)
| | - Edurne López Soberón
- Department of Cardiology, Hospital Central Defense Gómez Ulla, 28047 Madrid, Spain; (M.T.); (M.Á.S.); (E.L.S.); (A.S.); (D.M.S.)
| | - José A. Herrero Calvo
- Department of Nephrology, Hospital Clínico San Carlos, 28040 Madrid, Spain; (V.L.d.l.M.); (J.A.H.C.)
| | - Alfonso Suárez
- Department of Cardiology, Hospital Central Defense Gómez Ulla, 28047 Madrid, Spain; (M.T.); (M.Á.S.); (E.L.S.); (A.S.); (D.M.S.)
| | - David Martí Sánchez
- Department of Cardiology, Hospital Central Defense Gómez Ulla, 28047 Madrid, Spain; (M.T.); (M.Á.S.); (E.L.S.); (A.S.); (D.M.S.)
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Blanco-Fernández F, Antúnez-Muiños PJ, Núñez-García JC, López-Tejero S, Barreira-de Sousa GJ, García-Monsalvo M, Antúnez-Ballesteros M, Maree A, González-Calle D, Rodríguez-Collado J, Barreiro-Pérez M, Díaz-Peláez E, Pérez del Villar-Moro MC, Sánchez-Fernández PL, Cruz-González I. Effectiveness and Safety of an Outpatient Program for Percutaneous Left Atrial Appendage Occlusion. J Clin Med 2023; 12:6728. [PMID: 37959194 PMCID: PMC10648316 DOI: 10.3390/jcm12216728] [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: 09/12/2023] [Revised: 10/07/2023] [Accepted: 10/08/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Left atrial appendage occlusion (LAAO) is a safe and effective alternative to oral anticoagulation for thromboprophylaxis in patients with nonvalvular atrial fibrillation. Technological development in devices and imaging techniques, as well as accumulated experience, have increased procedural success rates and decreased complications. Same-day discharge protocols have been proposed in the field of structural heart disease, but this approach has not been studied in detail for the LAAO procedure. AIM The aim of this study is to assess the safety and efficacy of an outpatient program for LAAO when compared to the conventional treatment approach. METHODS We present a retrospective, non-randomized single-center study of 262 consecutive patients undergoing LAAO. Patients were divided into two groups, the first (n = 131) followed a conventional protocol (CP), and the second (n = 131) an outpatient protocol (OP). The primary composite endpoint comprised MACCE (death, stroke, and bleeding), cardiac tamponade, vascular complication, or attendance in the emergency department after hospital discharge at 30 days. RESULTS The overall success rate was 99.6%, with a periprocedural complication rate of 2.29%. With regards to the CP versus OP group, there were no differences between incidences of the primary composite endpoint (6.1% PC vs. 3.0% PA, p = 0.24), or after an analysis, with propensity score matching. No differences were observed in the individual endpoints. There was a decrease in hospital length of stay in the same-day discharge group (p < 0.01). CONCLUSIONS A same-day discharge LAAO program is safe, effective, and feasible when compared to the conventional strategy. Moreover, it reduces hospital length of stay, which might have clinical and economic benefits.
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Affiliation(s)
- Fabián Blanco-Fernández
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Pablo J. Antúnez-Muiños
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | | | - Sergio López-Tejero
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Gilles J. Barreira-de Sousa
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Mónica García-Monsalvo
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Milena Antúnez-Ballesteros
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | | | - David González-Calle
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Javier Rodríguez-Collado
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | | | - Elena Díaz-Peláez
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - María C. Pérez del Villar-Moro
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Pedro L. Sánchez-Fernández
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
| | - Ignacio Cruz-González
- Department of Cardiology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain (G.J.B.-d.S.)
- Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- Centro de Ivestigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 37007 Salamanca, Spain
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Tsiachris D, Papakonstantinou PE, Doundoulakis I, Tsioufis P, Botis M, Dimitriadis K, Leontsinis I, Kordalis A, Antoniou CK, Mantzouranis E, Iliakis P, Vlachakis PK, Gatzoulis KA, Tsioufis K. Anticoagulation Status and Left Atrial Appendage Occlusion Indications in Hospitalized Cardiology Patients with Atrial Fibrillation: A Hellenic Cardiorenal Morbidity Snapshot (HECMOS) Sub-Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1881. [PMID: 37893599 PMCID: PMC10608124 DOI: 10.3390/medicina59101881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/21/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The proper use of oral anticoagulants is crucial in the management of non-valvular atrial fibrillation (AF) patients. Left atrial appendage closure (LAAC) may be considered for stroke prevention in patients with AF and contraindications for long-term anticoagulant treatment. We aimed to assess anticoagulation status and LAAC indications in patients with AF from the HECMOS (Hellenic Cardiorenal Morbidity Snapshot) survey. Materials and Methods: The HECMOS was a nationwide snapshot survey of cardiorenal morbidity in hospitalized cardiology patients. HECMOS used an electronic platform to collect demographic and clinically relevant information from all patients hospitalized on 3 March 2022 in 55 different cardiology departments. In this substudy, we included patients with known AF without mechanical prosthetic valves or moderate-to-severe mitral valve stenosis. Patients with prior stroke, previous major bleeding, poor adherence to anticoagulants, and end-stage renal disease were considered candidates for LAAC. Results: Two hundred fifty-six patients (mean age 76.6 ± 11.7, 148 males) were included in our analysis. Most of them (n = 159; 62%) suffered from persistent AF. The mean CHA2DS2-VASc score was 4.28 ± 1.7, while the mean HAS-BLED score was 1.47 ± 0.9. Three out of three patients with a a CHA2DS2-VASc score of 0 or 1 (female) were inappropriately anticoagulated. Sixteen out of eighteen patients with a CHA2DS2-VASc score 1 or 2 (if female) received anticoagulants. Thirty-one out of two hundred thirty-five patients with a CHA2DS2-VASc score > 1 or 2 (if female) were inappropriately not anticoagulated. Relative indications for LAAC were present in 68 patients with NVAF (63 had only one risk factor and 5 had two concurrent risk factors). In detail, 36 had a prior stroke, 17 patients had a history of major bleeding, 15 patients reported poor or no adherence to the anticoagulant therapy and 5 had an eGFR value < 15 mL/min/1.73 m2 for a total of 73 risk factors. Moreover, 33 had a HAS-BLED score ≥ 3. No LAAC treatment was recorded. Conclusions: Anticoagulation status was nearly optimal in a high-thromboembolic-risk population of cardiology patients who were mainly treated using NOACs. One out of four AF patients should be screened for LAAC.
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Affiliation(s)
- Dimitris Tsiachris
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
- Athens Heart Center, Athens Medical Center, 15125 Athens, Greece
| | - Panteleimon E. Papakonstantinou
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Panagiotis Tsioufis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Michail Botis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Kyriakos Dimitriadis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Ioannis Leontsinis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
- Athens Heart Center, Athens Medical Center, 15125 Athens, Greece
| | - Emmanouil Mantzouranis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Panagiotis Iliakis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Panayotis K. Vlachakis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Konstantinos A. Gatzoulis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” Hospital, 11527 Athens, Greece; (P.E.P.); (I.D.); (P.T.); (M.B.); (K.D.); (I.L.); (A.K.); (C.-K.A.); (E.M.); (P.I.); (P.K.V.); (K.A.G.); (K.T.)
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7
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Jhand A, Goldsweig AM. The Emerging Role of Intracardiac Echocardiography (ICE) in Left Atrial Appendage Closure (LAAC). Curr Cardiol Rep 2023; 25:1223-1232. [PMID: 37610598 DOI: 10.1007/s11886-023-01940-4] [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] [Accepted: 08/11/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE OF REVIEW Intracardiac echocardiography (ICE) has emerged as a powerful imaging tool to guide percutaneous left atrial appendage closure (LAAC). Herein, we review an imaging protocol for ICE-guided LAAC and discuss the evidence for its use. RECENT FINDINGS Standardized imaging protocols have been proposed but have not been fully validated. ICE imaging yields similar procedural and clinical outcomes when compared to transesophageal echocardiography (TEE) to guide LAAC. Despite benefits of avoiding general anesthesia, TEE, and multiple physicians for LAAC procedures, ICE imaging remains under-utilized. Novel ICE catheters with 3D imaging capabilities may improve accuracy and efficiency of LAAC device implantation. ICE guidance is feasible, safe, and effective for LAAC. As the field evolves, further studies will be necessary to assess this technological advancement in imaging guidance.
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Affiliation(s)
- Aravdeep Jhand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA.
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Anduaga I, Affronti A, Cepas-Guillén P, Alcocer J, Flores-Umanzor E, Regueiro A, Brugaletta S, Quintana E, Sanchis L, Sabaté M, Freixa X. Non-Pharmacological Stroke Prevention in Atrial Fibrillation. J Clin Med 2023; 12:5524. [PMID: 37685589 PMCID: PMC10488500 DOI: 10.3390/jcm12175524] [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: 07/21/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide. It is associated with increased mortality and morbidity, especially due to the increased risk of ischemic stroke and systemic embolism in these patients. For this reason, thromboembolism prevention is the cornerstone of managing AF, and oral anticoagulation is nowadays the first-line treatment. However, since most thrombi form in the left atrial appendage and anticoagulant therapy may have side effects and be contraindicated in some patients, surgical and percutaneous left atrial appendage occlusion (LAAO) have emerged as a non-pharmacological alternative. This review summarizes all existing evidence on surgical and percutaneous LAAO.
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Affiliation(s)
- Iñigo Anduaga
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Alessandro Affronti
- Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Pedro Cepas-Guillén
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Jorge Alcocer
- Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Eduardo Flores-Umanzor
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Ander Regueiro
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Salvatore Brugaletta
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Eduard Quintana
- Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
| | - Laura Sanchis
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Manel Sabaté
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Xavier Freixa
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
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Agasthi P, Pujari SH. Peri- and Post-procedural Anticoagulation with Left Atrial Appendage Occlusion Devices. Heart Int 2023; 17:54-59. [PMID: 37456348 PMCID: PMC10339453 DOI: 10.17925/hi.2023.17.1.54] [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: 10/24/2022] [Accepted: 06/01/2023] [Indexed: 07/18/2023] Open
Abstract
In patients with atrial fibrillation and high stroke risk, anticoagulation with direct oral anticoagulants or vitamin K antagonists is the standard of care for stroke prevention. The benefit of anticoagulation is driven by attenuating the risk of thrombus formation in the left atrial appendage. Percutaneous left atrial appendage occlusion offers an alternative therapeutic strategy for stroke prevention in patients with high bleeding risk or contraindications for long-term anticoagulation. This review of the current literature delineates the standard protocols of peri- and post-procedural anticoagulation/antithrombotic therapy after left atrial appendage occlusion, the complications of the procedure, and the risk of device-related thrombosis and of incomplete occlusion of the appendage. Finally,the limitations and gaps in the literature are identified.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
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O'Sullivan D, O'Sullivan CJ, Maeder MT. Editorial: Novel methodologies in structural interventional cardiology: Case reports. Front Cardiovasc Med 2023; 10:1191819. [PMID: 37123471 PMCID: PMC10130635 DOI: 10.3389/fcvm.2023.1191819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
- David O'Sullivan
- Cardiology Department, Mater Misericordiae University Hospital, Dublin, Ireland
- Correspondence: David O'Sullivan Crochan J. O'Sullivan
| | - Crochan J. O'Sullivan
- Cardiology Department, Triemli Hospital, Zurich, Switzerland
- Cardiology Department, Bon Secours Hospital Cork, Cork, Ireland
- Correspondence: David O'Sullivan Crochan J. O'Sullivan
| | - Micha T. Maeder
- Cardiology Department, Cantonal Hospital St.Gallen, St. Gallen, Switzerland
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Alkhouli M, Silversides C. The "Adjacent Possible" and Cardiac Innovation. JACC. ADVANCES 2022; 1:100162. [PMID: 38939451 PMCID: PMC11198408 DOI: 10.1016/j.jacadv.2022.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
| | - Candice Silversides
- Address for correspondence: Dr Candice Silversides, Mount Sinai Hospital, 700 University Avenue, Room 9-913, Toronto M5G 1Z5, Canada.
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