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Galea R, Räber L, Fuerholz M, Häner JD, Siontis GCM, Brugger N, Moschovitis A, Heg D, Fischer U, Meier B, Windecker S, Valgimigli M. Impact of Echocardiographic Guidance on Safety and Efficacy of Left Atrial Appendage Closure: An Observational Study. JACC Cardiovasc Interv 2021; 14:1815-1826. [PMID: 34412799 DOI: 10.1016/j.jcin.2021.05.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of echocardiographic guidance on the safety and efficacy of left atrial appendage closure (LAAC). BACKGROUND Expert consensus documents recommend intraprocedural imaging by means of either transesophageal echocardiography or intracardiac echocardiography to guide LAAC. However, no evidence exists that intraprocedural echocardiographic guidance in addition to fluoroscopy improves the safety and efficacy of LAAC. METHODS Consecutive LAAC procedures performed at a high-volume center between January 2009 and October 2020 were stratified on the basis of intraprocedural imaging modalities, including fluoroscopic guidance (FG) only or intraprocedural echocardiographic guidance (EG) in addition to fluoroscopy. The primary safety endpoint was the composite of procedure-related complications occurring within 7 days after the procedure. Technical success at 7 days and at follow-up were secondary endpoints. RESULTS Among 811 LAAC procedures, 549 (67.7%) and 262 (32.3%) were assigned to the FG and EG groups, respectively. After adjusting for confounders, EG remained associated with a lower rate of the primary safety endpoint (3.4% vs 9.1%; P = 0.004; adjusted odds ratio [OR]: 0.31; 95% CI: 0.11-0.90; P = 0.030). Technical success trended higher at 7 days (92.1% vs 87.2%; P = 0.065; adjusted OR: 1.68; 95% CI: 0.95-3.01; P = 0.079) and was significantly improved with EG compared with FG (87.6% vs 79.9%; P = 0.018; OR: 4.06; 95% CI: 1.60-10.27; P = 0.003) after a median follow-up period of 4.9 months (interquartile range: 3.4 months-6.2 months). CONCLUSIONS In a large cohort of consecutive LAACs, the use of intraprocedural echocardiography to guide intervention in addition to standard fluoroscopy was associated with lower risks for procedural complications and higher mid-term technical success rates.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Monika Fuerholz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas D Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aris Moschovitis
- Department of Cardiology, HerzZentrum Hirslanden, Zürich, Switzerland
| | - Dik Heg
- Department of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
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Wang J, Rong B, Zhang K, Chen T, Lin M, Han W, Sha R, Wang S, Feng X, Zhong JQ. Feasibility and safety of left atrial appendage occlusion guided by procedural fluoroscopy only: A pilot study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1207-1215. [PMID: 34101856 DOI: 10.1111/pace.14292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/26/2021] [Accepted: 06/06/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Left atrial appendage occlusion (LAAO) is usually performed via the guidance of procedural transesophageal echocardiography (TEE) companied by general anesthesia (GA). OBJECTIVE To investigate the feasibility and safety of LAAO guided by procedural fluoroscopy only. METHODS The patients eligible for LAAO were enrolled into the current study and received implantation of either Watchman device or LAmbre device. The procedure was carried out with procedural fluoroscopy only and no companied GA; the position, shape, and leakage of the device were assessed by contrast angiography. TEE was performed after 3-month follow-up to evaluate the thrombosis, and leakage of device. RESULTS Ninety-seven patients with atrial fibrillation (AF) with either Watchman device (n = 49) or LAmbre device (n = 48) were consecutively enrolled. Watchman device group was of lower CHA2 DS2 -VASc and HAS-BLED scores compared with LAmbre device groups (p < .05); the two groups had similar distributions of other baseline characteristics (p > .05), including procedural success rate (98.0% vs. 97.9%), mean procedure time, mean fluoroscopy time, total radiation dose, contrast medium dose, percentage of peri-device leakage. Pericardial effusions requiring intervention occurred in two of the Watchman group. TEE follow-up found no patient with residual leakage ≥5 mm at 3 months and no device related thrombosis (DRT). During the 22.0 ± 11.1 months follow-up, two patients experienced ischemic stroke. CONCLUSIONS LAAO with the procedural imaging of fluoroscopy only exhibited the promising results of efficacy and safety. A prospective randomized multicenter study would be required to verify the observations in this study.
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Affiliation(s)
- Juntao Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Bing Rong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Geriatric Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Kai Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tongshuai Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mingjie Lin
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Wenqiang Han
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Rina Sha
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shoudong Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Xuan Feng
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Jing-Quan Zhong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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Kleinecke C, Buffle E, Link J, Häner J, Sedaghat A, Galea R, Streit SR, Windecker S, Meier B, Gloekler S. Amplatzer left atrial appendage closure: Single versus combined procedures. Catheter Cardiovasc Interv 2021; 97:E973-E981. [PMID: 32930492 DOI: 10.1002/ccd.29271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/27/2020] [Accepted: 08/31/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study compares procedural and late clinical outcomes of left atrial appendage closure (LAAC) with Amplatzer devices as a single versus a combined procedure with other structural or coronary interventions. BACKGROUND Multiple cardiac conditions are frequent among elderly patients and invite simultaneous treatment to ensure a favorable patient outcomes. METHODS 559 consecutive patients (73.3 ± 11.1 years) underwent LAAC with Amplatzer devices at two centres (Bern and Zurich university hospitals, Switzerland) either as a single procedure or combined with other interventions. The primary safety endpoint was a composite of major peri-procedural complications and major bleeding at follow-up, the primary efficacy endpoint included stroke, systemic embolism, and cardiovascular/unexplained death. All event rates are reported per 100 patient-years. RESULTS In 263 single and 296 combined procedures with percutaneous coronary interventions (47.6%), closure of an atrial septal defect (8.4%) or a patent foramen ovale (36.5%), transcatheter aortic valve implantation (10.1%), mitral clipping (4.1%), atrial fibrillation ablation (8.8%), or another procedure (3.0%) were analyzed. Device success (96.6% [single] vs. 99.0% [combined], p = .08) did not differ between the groups. After a mean follow-up of 2.6 ± 1.5 vs. 2.5 ± 1.5 years and a total of 1,422 patient-years, the primary efficacy (40/677, 5.9% [single] vs. 37/745, 5.0% [combined]; HR, 1.2, 95% CI, 0.8-1.9, p = .44), as well as the primary safety endpoint (25/677, 3.7% vs 28/745, 3.8%; HR, 1.0, 95% CI, 0.6-1.8, p = .89) were comparable. CONCLUSIONS LAAC with Amplatzer devices combined with structural, coronary, and electrophysiological procedures offers procedural feasibility and safety, as well as long-term efficacy.
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Affiliation(s)
- Caroline Kleinecke
- Cardiology, Klinikum Lichtenfels, Lichtenfels, Germany.,Cardiology, Klinikum Hochrhein, Waldshut-Tiengen, Germany
| | - Eric Buffle
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Juergen Link
- Department of Anesthesiology, Dreifaltigkeits-Hospital, Wesseling, Germany
| | - Jonas Häner
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | | | - Roberto Galea
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Samuel R Streit
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Stephan Windecker
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Steffen Gloekler
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.,Cardiology, Klinikum Hochrhein, Waldshut-Tiengen, Germany
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Häner JD, Fürholz M, Kleinecke C, Galea R, Streit SR, Fankhauser M, Cherni T, Valgimigli M, Windecker S, Meier B, Gloekler S. Impact of individual stroke risk on outcome after Amplatzer left atrial appendage closure in patients with atrial fibrillation. Catheter Cardiovasc Interv 2021; 97:E1002-E1010. [PMID: 33022121 DOI: 10.1002/ccd.29318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/26/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To investigate periprocedural and long-term outcome of left atrial appendage closure (LAAC) using Amplatzer occluders with respect to individual pre-procedural stroke risk. BACKGROUND LAAC is a proven strategy for prevention from stroke and bleeding in patients with nonvalvular atrial fibrillation not amenable to oral anticoagulation. Whether individual pre-procedural stroke risk may affect procedural and long-term clinical outcome after LAAC is unclear. METHODS Multicenter study of consecutive patients who underwent Amplatzer-LAAC. Using pre-procedural CHADS2 score, outcomes were compared between a low (0-2 points) and a high stroke risk group (3-6 points). RESULTS Five hundred consecutive patients (73.9 ± 10.1 years) who underwent Amplatzer-LAAC. Two hundred and forty eight had preprocedural CHADS2 score ≤ 2 points (low-risk group) and the remaining 252 patients had 3-6 points (high-risk group). Periprocedural complication rates (6.0% vs. 5.6%, p = .85), procedural success (LAAC without major periprocedural or device-related complications or major para-device leaks: 89.4% vs. 87.9%, p = .74), and 30-day-mortality (2.4% vs. 2.6%, p = .77) were comparable. After 1,346 patient-years (PY), the long-term composite efficacy endpoint (stroke, systemic embolism, cardiovascular, and unexplained death) was reached in 23/653 (3.5/100 PY) versus 52/693 (7.5/100 PY); HR = 2.13; 95%-CI, 1.28-3.65, p = .002) with stroke rates 67% and 68% lower than anticipated by preprocedural CHADS2 score. Combined safety endpoint (major periprocedural complications and major, life-threatening or fatal bleedings) occurred in 22/653 (3.4/100 PY) versus 28/693 (4.0/100 PY); HR = 1.20; 95%-CI, 0.66-2.20, p = .52). CONCLUSIONS Compared with patients at low risk of stroke, LAAC with Amplatzer devices is associated with similar safety and efficacy in high-risk patients in our study.
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Affiliation(s)
- Jonas D Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Monika Fürholz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel R Streit
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mate Fankhauser
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Takwa Cherni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.,Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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5
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Percutaneous Left Atrial Appendage Occlusion: An Emerging Option in Patients with Atrial Fibrillation at High Risk of Bleeding. ACTA ACUST UNITED AC 2021; 57:medicina57050444. [PMID: 34063719 PMCID: PMC8147783 DOI: 10.3390/medicina57050444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/22/2021] [Accepted: 04/29/2021] [Indexed: 12/31/2022]
Abstract
Atrial fibrillation (AF) is a common cardiac arrhythmia with an estimated prevalence of 1% in the general population. It is associated with an increased risk of ischemic stroke, silent cerebral ischemia, and cognitive impairment. Due to the blood flow stasis and morphology, thrombus formation occurs mainly in the left atrial appendage (LAA), particularly in the setting of nonvalvular AF (NVAF). Previous studies have shown that >90% of emboli related to NVAF originate from the LAA, thus prevention of systemic cardioembolism is indicated. According to the current guidelines, anticoagulant therapy with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs), represents the standard of care in AF patients, in order to prevent ischemic stroke and peripheral embolization. Although these drugs are widely used and DOACs have shown, compared to VKAs, non-inferiority for stroke prevention with significantly fewer bleeding complications, some issues remain a matter of debate, including contraindications, side effects, and adherence. An increasing number of patients, indeed, because of high bleeding risk or after experiencing life-threatening bleedings, must take anticoagulants with extreme caution if not contraindicated. While surgical closure or exclusion of LAA has been historically used in patients with AF with contradictory results, in the recent years, a novel procedure has emerged to prevent the cardioembolic stroke in these patients: The percutaneous left atrial appendage occlusion (LAAO). Different devices have been developed in recent years, though not all of them are approved in Europe and some are still under clinical investigation. Currently available devices have shown a significant decrease in bleeding risk while maintaining efficacy in preventing thromboembolism. The procedure can be performed percutaneously through the femoral vein access, under general anesthesia. A transseptal puncture is required to access left atrium and is guided by transesophageal echocardiography (TEE). Evidence from the current literature indicates that percutaneous LAAO represents a safe alternative for those patients with contraindications for long-term oral anticoagulation. This review summarizes scientific evidences regarding LAAO for stroke prevention including clinical indications and an adequate patient selection.
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Jackson LR, Jackson KP, Thomas KL. Percutaneous left atrial appendage occlusion: A review of current devices, clinical evidence, patient selection, and post procedural antithrombotic management. Prog Cardiovasc Dis 2021; 66:92-100. [PMID: 34332665 PMCID: PMC9899495 DOI: 10.1016/j.pcad.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Stroke is a major driver of increased morbidity and mortality in patients with non-valvular atrial fibrillation (NVAF). While systemic oral anticoagulation (OAC) continues to be the mainstay for stroke reduction therapy in patients with NVAF, several barriers prevent the sustained long-term use of OAC, including increased risk of bleeding, non-compliance, cost, drug-drug interactions, and the need for ongoing laboratory testing. Given the need for continued stroke reduction therapies in patients who are intolerant of or non-compliant with OAC, percutaneous left atrial appendage (LAA) occlusion (LAAO) has emerged as a nonpharmacologic alternative to OAC. The development of percutaneous LAAO techniques is based on data suggesting that more than 90% of thrombi in patients with NVAF originate in the LAA. Two percutaneous LAAO devices are currently in widespread clinical use: Watchman (United States and Europe) and the Amplatzer type of devices (Europe); randomized trial data exist only for the Watchman device. Multiple randomized and nonrandomized trials and registries have demonstrated the safety and effectiveness of LAAO in patients who are suitable for short-term anticoagulation using a variety of post-procedural antithrombotic strategies. Ongoing randomized clinical trials on LAAO are focused on OAC-ineligible patients to compare efficacy of LAAO devices against a multitude of antithrombotic options. This review aims to discuss the rationale and evidence for LAAO and post procedural antithrombotic strategies and opportunities for research examination. In addition, we discuss the need for continued investigation of LAAO in populations not well represented in clinical trials or registries, including women, older patients, and underrepresented racial and ethnic groups.
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Affiliation(s)
- Larry R Jackson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America; Duke Center for Atrial Fibrillation and Clinical Cardiac Electrophysiology Section, Duke University Medical Center, Durham, NC, United States of America.
| | - Kevin P Jackson
- Duke Center for Atrial Fibrillation and Clinical Cardiac Electrophysiology Section, Duke University Medical Center, Durham, NC, United States of America
| | - Kevin L Thomas
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America; Duke Center for Atrial Fibrillation and Clinical Cardiac Electrophysiology Section, Duke University Medical Center, Durham, NC, United States of America
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7
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Freitas-Ferraz AB, Bernier M, O'Connor K, Beaudoin J, Champagne J, Paradis JM, O'Hara G, Muntané-Carol G, Alperi A, Faroux L, Junquera L, Rodés-Cabau J. Safety and effects of volume loading during transesophageal echocardiography in the pre-procedural work-up for left atrial appendage closure. Cardiovasc Ultrasound 2021; 19:3. [PMID: 33388071 PMCID: PMC7778814 DOI: 10.1186/s12947-020-00230-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/03/2020] [Indexed: 12/05/2022] Open
Abstract
Background In patients undergoing left atrial appendage (LAA) closure, an accurate sizing of the LAA is key to optimize device sizing, procedural success and reduce complications. Previous studies have shown that intraprocedural volume loading increases LAA dimensions and improves device sizing. However, the safety and effects on LAA and device sizing of administering a fluid bolus during pre-procedural transesophageal echocardiography (TEE) are unknown. The aim of this study was to determine the safety and impact on LAA dimensions and device sizing of an intravenous (IV) fluid bolus administered during TEE in the setting of the pre-procedural work-up for LAA closure. Methods The study included a total of 72 patients who underwent TEE to assess suitability for LAAC and received a 500 ml IV bolus of normal saline. The LAA landing zone (LZ) and depth were measured by TEE before and after volume loading, and these measurements were used to predict the device size implanted during a subsequent percutaneous LAAC procedure. Results There were no complications associated with volume loading. The baseline mean LZ was 19.6 ± 3.6 mm at 90o, and 20.2 ± 4.1 mm at 135o. Following fluid bolus, the maximum diameter increased 1.5 ± 1.0 mm at 90o (p<0.001), and 1.3 ± 1.0 mm at 135o (p<0.001). The baseline mean depth of the LAA was 26.5 ± 5.5 mm at 90o, and 23.9 ± 5.8 mm at 135o. After fluid bolus, the mean depth increased by 1.5 ± 1.8 mm (p<0.001) and 1.6 ± 2.0 (p<0.001), at 90o and 135o, respectively. Sizing based on post-bolus measurements of the LZ significantly improved the agreement with the final device size selection during the procedure in 71.0% of cases (vs. 42.0% with pre-bolus measurements). Conclusions Volume loading during ambulatory TEE as part of the pre-procedural work-up of LAAC is safe and significantly increases LAA dimensions. This strategy may become the new standard, particularly in centers performing LAAC with no TEE guidance, as it improves LAA sizing and more accurately predicts the final device size.
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Affiliation(s)
- Afonso B Freitas-Ferraz
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Mathieu Bernier
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada.
| | - Kim O'Connor
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Jean Champagne
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Jean-Michel Paradis
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Gilles O'Hara
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Guillem Muntané-Carol
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Alberto Alperi
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Laurent Faroux
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Lucia Junquera
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada.
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8
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Gloekler S, Fürholz M, de Marchi S, Kleinecke C, Streit SR, Buffle E, Fankhauser M, Häner JD, Nietlispach F, Galea R, Windecker S, Meier B. Left atrial appendage closure versus medical therapy in patients with atrial fibrillation: the APPLY study. EUROINTERVENTION 2020; 16:e767-774. [DOI: 10.4244/eij-d-20-00201] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Kleinecke C, Gloekler S, Meier B. Utilization of percutaneous left atrial appendage closure in patients with atrial fibrillation: an update on patient outcomes. Expert Rev Cardiovasc Ther 2020; 18:517-530. [DOI: 10.1080/14779072.2020.1794820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Caroline Kleinecke
- Cardiology, Internal Medicine Department, Klinikum Lichtenfels, Lichtenfels, Germany
| | - Steffen Gloekler
- Cardiology, Internal Medicine Department, Klinikum Hochrhein, Waldshut-Tiengen, Germany and Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
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10
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Ding WY, Mandrola J, Gupta D. Left Atrial Appendage Occlusion: Past, Present and Future. Thromb Haemost 2020; 120:1484-1491. [DOI: 10.1055/s-0040-1714654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AbstractThere are several situations whereby oral anticoagulation may be unsuitable for stroke prevention in patients with atrial fibrillation (AF). Percutaneous left atrial appendage (LAA) occlusion has received much attention in this area. Various devices have already been developed and tested for this purpose. Data from registries and cohort studies have indicated favourable short- and long-term outcomes with LAA occlusion, and several international guidelines recommend its use in AF patients with contraindications to oral anticoagulation. However, prospective controlled trials in this very population are lacking. Furthermore, while modelling studies on cost analyses have suggested that LAA occlusion may be a cost-effective strategy compared with standard medical therapy, these have not been performed in high-risk patients who may have limited survival in the medium to long term. Thus, while LAA occlusion offers promise, there is a strong need for additional research to investigate its exact role, its long-term outcomes and cost efficacy.
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Affiliation(s)
- Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, Department of Cardiology, University of Liverpool, Liverpool, United Kingdom
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - John Mandrola
- Department of Cardiology, Baptist Health Louisville, Louisville, Kentucky, United States
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, Department of Cardiology, University of Liverpool, Liverpool, United Kingdom
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
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Kleinecke C, Fuerholz M, Buffle E, de Marchi S, Schnupp S, Brachmann J, Nietlispach F, Fankhauser M, Streit SR, Windecker S, Meier B, Gloekler S. Transseptal puncture versus patent foramen ovale or atrial septal defect access for left atrial appendage closure. EUROINTERVENTION 2020; 16:e173-e180. [PMID: 31449043 DOI: 10.4244/eij-d-19-00442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to compare the periprocedural and late clinical outcomes of left atrial appendage closure (LAAC) with AMPLATZER devices by access through transseptal puncture (TSP) versus a patent foramen ovale (PFO) or an atrial septal defect (ASD). METHODS AND RESULTS Between 2009 and 2018, 578 consecutive patients underwent LAAC via TSP or PFO/ASD access in three centres. After a 3:1 propensity score matching, 246 (TSP) versus 91 (PFO/ASD) patients were compared using the primary efficacy endpoint of all-cause stroke, systemic embolism and cardiovascular/unexplained death and the primary safety endpoint of major periprocedural complications and major bleedings at follow-up. Mean age was 75.2±8.7 (TSP) vs 74.4±10.9 (PFO/ASD) years, CHA2DS2-VASc score 4.5±1.6 vs 4.3±1.4 and HAS-BLED score 3.3±1.0 vs 3.3±0.9. Device success (97.6% vs 97.8%, p=0.90) was similar. After 2.5±1.4 vs 2.6±1.6 years, clinical efficacy (46/603, 7.6% [TSP] vs 21/233, 9.0% [PFO/ASD], hazard ratio [HR] 1.2; 95% confidence interval [CI]: 0.69-0.85, p=0.54) and safety (24/603, 4.0% vs 11/233, 4.7%; HR 1.4; 95% CI: 0.52-3.6, p=0.49) did not differ. CONCLUSIONS Use of a PFO/ASD access for LAAC with AMPLATZER devices offers similar periprocedural and late clinical outcomes to TSP. Simultaneous PFO/ASD closure for an additional protective benefit does not increase risk.
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Akella K, Yarlagadda B, Murtaza G, Della Rocca DG, Gopinathannair R, Natale A, Lakkireddy D. Epicardial versus Endocardial Closure: Is One Better than the Other? Card Electrophysiol Clin 2020; 12:97-108. [PMID: 32067652 DOI: 10.1016/j.ccep.2019.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Left atrial appendage occlusion is an evolving technology with demonstrable benefits of stroke prophylaxis in patients with atrial fibrillation unsuitable for anticoagulation. This has resulted in the development of a plethora of transcatheter devices to achieve epicardial exclusion and endocardial occlusion. In this review, the authors summarize the differences in technique, target patient population, outcomes, and complication profiles of endocardial and epicardial techniques.
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Affiliation(s)
- Krishna Akella
- The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA
| | - Bharath Yarlagadda
- Department of Cardiology, University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Ghulam Murtaza
- The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA; Department of Biomedical Engineering, University of Texas, 107 West Dean Keeton Street, Austin, TX 78712, USA
| | - Rakesh Gopinathannair
- The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA; Department of Biomedical Engineering, University of Texas, 107 West Dean Keeton Street, Austin, TX 78712, USA
| | - Dhanunjaya Lakkireddy
- The Kansas City heart rhythm institution and research foundation, HCA MIDWEST HEALTH, Second Floor, 5100 W 110th St, Overland Park, KS 66211, USA.
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13
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Della Rocca DG, Horton RP, Di Biase L, Bassiouny M, Al-Ahmad A, Mohanty S, Gasperetti A, Natale VN, Trivedi C, Gianni C, Burkhardt JD, Gallinghouse GJ, Hranitzky P, Sanchez JE, Natale A. First Experience of Transcatheter Leak Occlusion With Detachable Coils Following Left Atrial Appendage Closure. JACC Cardiovasc Interv 2020; 13:306-319. [DOI: 10.1016/j.jcin.2019.10.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
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14
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Kleinecke C, Yu J, Neef P, Buffle E, de Marchi S, Fuerholz M, Nietlispach F, Valgimigli M, Streit SR, Fankhauser M, Duenninger E, Windecker S, Meier B, Gloekler S. Clinical outcomes of Watchman vs. Amplatzer occluders for left atrial appendage closure (WATCH at LAAC). Europace 2020; 22:916-923. [DOI: 10.1093/europace/euaa001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/05/2020] [Indexed: 12/16/2022] Open
Abstract
Abstract
Aims
This study compares clinical outcomes of Watchman vs. Amplatzer devices for left atrial appendage closure (LAAC).
Methods and results
Of two real-world registries, the Watchman registry Lichtenfels, Germany, and the Amplatzer registry Bern-Zurich, Switzerland, 303 and 333 consecutive patients, respectively, were included. After a 1:1 propensity score matching, 266 vs. 266 patients were compared by use of the predefined primary efficacy endpoint of stroke, systemic embolism and cardiovascular/unexplained death, the primary safety endpoint of major peri-procedural complications and major bleeding events at follow-up, and the combined hazard endpoint, a composite of all above-mentioned hazards. Mean age was 75.3 ± 7.8 (Watchman) vs. 75.1 ± 9.9 (Amplatzer) years, CHA2DS2-VASc score 4.5 ± 1.7 vs. 4.5 ± 1.5, and HAS-BLED score 3.2 ± 1.0 vs. 3.2 ± 1.0. At a mean follow-up of 2.4 ± 1.3 vs. 2.5 ± 1.5 years and 1.322 patient-years, the primary endpoints of efficacy [40/646, 6.2% [Watchman] vs. 43/676, 6.4% [Amplatzer]; hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.66–1.58; P = 0.92] and safety (33/646, 5.1% vs. 30/676, 4.4%; HR, 0.57; 95% CI, 0.29–1.11; P = 0.10), as well as the combined hazard endpoint (69/646, 10.7% vs. 66/676, 9.8%; HR, 0.80; 95% CI, 0.55–1.12; P = 0.26) were similar for both groups.
Conclusion
This study suggests comparable efficacy and safety of the Watchman and Amplatzer devices.
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Affiliation(s)
- Caroline Kleinecke
- Department of Cardiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
| | - Jiangtao Yu
- Department of Cardiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
| | - Philip Neef
- Department of Cardiology, Schwarzwald-Baar Klinikum, Klinikstraße 11, 78052 Villingen-Schwenningen, Germany
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Eric Buffle
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Stefano de Marchi
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Monika Fuerholz
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
- Cardiovascular Center Zurich, Hirslanden Klinik Im Park, Zurich, Switzerland
| | - Marco Valgimigli
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Samuel R Streit
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Mate Fankhauser
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Erich Duenninger
- Department of Cardiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
| | - Stephan Windecker
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, Schwarzwald-Baar Klinikum, Klinikstraße 11, 78052 Villingen-Schwenningen, Germany
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15
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Gotzmann M, Choudhury DS, Hogeweg M, Heringhaus F, Mügge A, Pflaumbaum A. Risk stratification in patients undergoing interventional left atrial appendage occlusion-Prognostic impact of EuroSCORE II. Clin Cardiol 2020; 43:508-515. [PMID: 31967662 PMCID: PMC7244292 DOI: 10.1002/clc.23338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 12/23/2022] Open
Abstract
Background Interventional closure of the left atrial appendage (LAA) is an alternative option to stroke prophylaxis, particularly in multimorbid patients with a high risk of bleeding under oral anticoagulation. Due to the multiple comorbidities, the prognosis of patients is reduced, and the clinical benefit of the procedure is therefore questionable in the individual patient. Hypothesis The present study aims to identify independent preprocedural risk factors to improve risk stratification in these highly selected patients. Methods This study consecutively included 128 patients who received an interventional LAA occlusion with Amplatzer device (St Jude Medical, St Paul, Minnesota). The preinterventional risk assessment was performed with the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) II. The primary endpoint was all‐cause mortality. Secondary endpoints were thromboembolic events and severe bleeding. Results During a follow‐up of 781 ± 498 days the primary endpoint (all‐cause mortality) was reached in 35 patients (27%). The only independent predictor of mid‐term mortality was a logistic EuroSCORE II > 2% (Hazard risk [HR] 4.55, confidence interval [CI] 1.599‐12.966, P = .005). In our study, 33 patients (26%) suffered from end‐stage renal disease which was not associated with increased mortality (P = .371), increased thromboembolic events (P = .475), or severe bleeding (P = .613). Conclusions In patients undergoing interventional LAA occlusion, preprocedural assessment of logistic EuroSCORE II provide independent prognostic information. This parameter might help to improve risk stratification in these highly selected patients. In contrast, terminal renal failure was not associated with a significantly worse outcome.
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Affiliation(s)
- Michael Gotzmann
- Cardiovascular Center, St. Josef Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Dinah S Choudhury
- Department of Cardiology, Marien Hospital Witten, Ruhr University, Bochum, Germany
| | - Maximilian Hogeweg
- Cardiovascular Center, St. Josef Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Florian Heringhaus
- Cardiovascular Center, St. Josef Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Andreas Mügge
- Cardiovascular Center, St. Josef Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Andreas Pflaumbaum
- Department of Cardiology, Marien Hospital Witten, Ruhr University, Bochum, Germany
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16
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Kleinecke C, Cheikh‐Ibrahim M, Schnupp S, Fankhauser M, Nietlispach F, Park J, Brachmann J, Windecker S, Meier B, Gloekler S. Long‐term clinical outcomes of Amplatzer cardiac plug versus Amulet occluders for left atrial appendage closure. Catheter Cardiovasc Interv 2019; 96:E324-E331. [DOI: 10.1002/ccd.28530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/05/2019] [Accepted: 09/19/2019] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Mate Fankhauser
- Cardiology, Cardiovascular DepartmentUniversity Hospital of Bern Bern Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland, and Cardiovascular Center ZurichHirslanden Klinik im Park Zurich Switzerland
| | - Jai‐Wun Park
- Department of CardiologyCharité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
| | | | - Stephan Windecker
- Cardiology, Cardiovascular DepartmentUniversity Hospital of Bern Bern Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular DepartmentUniversity Hospital of Bern Bern Switzerland
| | - Steffen Gloekler
- Cardiology, Cardiovascular DepartmentUniversity Hospital of Bern Bern Switzerland
- Department of Cardiology, Schwarzwald‐Baar Klinikum,Villingen‐SchwenningenGermany, and University of Bern, Faculty of Medicine Bern Switzerland
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17
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Fastner C, Nienaber CA, Park JW, Brachmann J, Zeymer U, Goedde M, Sievert H, Geist V, Lewalter T, Krapivsky A, Käunicke M, Maier J, Özdemir B, Hochadel M, Schneider S, Senges J, Akin I. Impact of left atrial appendage morphology on indication and procedural outcome after interventional occlusion: results from the prospective multicentre German LAARGE registry. EUROINTERVENTION 2019; 14:151-157. [PMID: 29508766 DOI: 10.4244/eij-d-17-00866] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Interventional left atrial appendage closure (LAAC) is an emerging alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) in concomitance with a contraindication for standard OAC. This sub-analysis of the LAARGE registry aimed to investigate differences between different LAA morphologies in a real-world setting. METHODS AND RESULTS This prospective, multicentre, observational registry included 562 patients from 37 centres with ineligibility for long-term OAC between April 2014 and January 2016. Baseline characteristics, indications, procedural data and complications were registered according to each LAA morphology (i.e., chicken wing, cauliflower, windsock, cactus and atypical morphologies). Implantation success was high across the four typical anatomies (≥97.5%, p=n.s.); only atypical anatomies exhibited a lower success rate (94%). The cactus-shaped LAA was linked to a trend indicating a shorter fluoroscopy time, while the atypical LAA was linked to a significantly prolonged fluoroscopy time (p=0.089 and p=0.025 versus the overall mean, respectively). Periprocedural and intra-hospital complications were generally rare, with no differences among the different morphologies (p=n.s.). CONCLUSIONS Procedural success as well as the complication rates of LAAC were not different among the four typical LAA morphologies. A lower implantation success rate was only obvious in patients with atypical LAA morphologies.
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Affiliation(s)
- Christian Fastner
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, University of Heidelberg, Mannheim, Germany
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18
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Sedaghat A, Vij V, Streit SR, Schrickel JW, Al-Kassou B, Nelles D, Kleinecke C, Windecker S, Meier B, Valglimigli M, Nietlispach F, Nickenig G, Gloekler S. Incidence, predictors, and relevance of acute kidney injury in patients undergoing left atrial appendage closure with Amplatzer occluders: a multicentre observational study. Clin Res Cardiol 2019; 109:444-453. [DOI: 10.1007/s00392-019-01524-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/30/2019] [Indexed: 11/30/2022]
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19
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Glassy MS, Wung W, Westcott S, Smith TW, Fan D, Rogers JH, Singh GD. Watchman Occlusion in Long-Standing Persistent Atrial Fibrillation. JACC Cardiovasc Interv 2019; 12:1018-1026. [DOI: 10.1016/j.jcin.2019.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/05/2019] [Accepted: 04/02/2019] [Indexed: 11/24/2022]
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20
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Rocca DGD, Prete AD, Biase LD, Horton RP, Al-Ahmad A, Bassiouny M, Mohanty S, Trivedi C, Romero J, Gianni C, Burkhardt JD, Gallinghouse GJ, Sanchez JE, Versaci F, Natale A. Current Endocardial Approaches for Left Atrial Appendage Closure. ACTA ACUST UNITED AC 2019. [DOI: 10.17925/ejae.2019.5.1.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Amabile N, Elhadad S, Roig C, Sebag F, Charles P, Caussin C. [Left atrial appendage occlusion in elderly]. Ann Cardiol Angeiol (Paris) 2018; 67:444-449. [PMID: 30376971 DOI: 10.1016/j.ancard.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Left atrial appendage occlusion (LAAO) is an alternative option to oral anticoagulation therapy in patients with non-valvular atrial fibrillation. According to French regulations, this procedure is currently reserved for patients with formal contraindications to VKA and direct thrombin inhibitors. LAAO procedures reduce ischemic and stroke risks compared to no treatment and also reduce bleeding events compared to VKA therapy in eligible patients. The peri-procedural complications risk has been reported to be limited in the different series published so far. Although elderly patients (>75 years) have either higher ischemic and bleeding risk than younger subjects, they hardly benefit from optimal anticoagulation. Thus, these subjects might greatly benefit from LAAO. Published studies reported excellent feasibility and efficiency of LAAO procedure in elderly patients. Yet there is a trend towards a higher incidence of peri-procedural complications (including tamponade), long-term safety is excellent and comparable to what is observed in patients<75 years. Therefore, interventional percutaneous LAAO is an attractive strategy in elderly patients with atrial fibrillation that should be incorporated in a multidisciplinary management.
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Affiliation(s)
- N Amabile
- Service de cardiologie, institut mutualiste Montsouris, 75014 Paris, France.
| | - S Elhadad
- Service de cardiologie, CH Marne la Vallée, 77600 Jossigny, France
| | - C Roig
- Service de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | - F Sebag
- Service de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | - P Charles
- Service de médecine interne, institut mutualiste Montsouris, 75014 Paris, France
| | - C Caussin
- Service de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
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22
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Percutaneous Left Atrial Appendage Closure With the Ultraseal Device. JACC Cardiovasc Interv 2018; 11:1932-1941. [DOI: 10.1016/j.jcin.2018.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/01/2018] [Accepted: 05/15/2018] [Indexed: 11/22/2022]
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Wisst T, Meincke F, Spangenberg T, Wienemann H, Reinholz C, Kreidel F, Kuck KH, Ghanem A. Safety and feasibility of interventional left atrial appendage closure without contrast agent. ASIAINTERVENTION 2018; 4:126-133. [PMID: 36484002 PMCID: PMC9706726 DOI: 10.4244/aij-d-17-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/09/2018] [Indexed: 06/17/2023]
Abstract
AIMS Interventional left atrial appendage closure (LAAC) is routinely performed under both echocardiographic and angiographic guiding. However, adverse outcomes, e.g., kidney injury and cerebral embolism, might be associated with injections of contrast agent into the LAA. Therefore, this prospective registry investigated the safety and feasibility of LAAC without the support of angiographic images as the default approach. METHODS AND RESULTS This single-centre registry included a total of 46 non-selected, consecutive patients. In the first 25 patients (54%), LAAC with the Amulet device was performed routinely with LAA angiography prior to implantation and after release of the device. The following 21 patients (46%) were treated without the use of contrast agent. The combination of successful implantation and lack of procedural complications was regarded as the primary endpoint. Procedure time, number of recapture manoeuvres, change of device size, compression, leakage, dose area product and late thrombosis on the device were investigated as secondary endpoints. Besides the longer fluoroscopy time and duration of the procedure in the group using angiography, no significant differences could be found. Major complications occurred equally often in both cohorts. CONCLUSIONS Interventional LAAC with the Amulet device can be performed safely without the use of contrast agent. This approach might help to enhance the use of LAAC in patients at high risk of contrast-induced nephropathy and procedural stroke.
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Affiliation(s)
- Theresa Wisst
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Felix Meincke
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Hendrik Wienemann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Claudia Reinholz
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Felix Kreidel
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Alexander Ghanem
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
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Sharma SP, Park P, Lakkireddy D. Left Atrial Appendages Occlusion: Current Status and Prospective. Korean Circ J 2018; 48:692-704. [PMID: 30073807 PMCID: PMC6072669 DOI: 10.4070/kcj.2018.0231] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 12/21/2022] Open
Abstract
Stroke continues to be a major cause of morbidity and mortality in atrial fibrillation (AF) patients. Oral anticoagulation (OAC) provides protection against stroke and peripheral embolization in AF but significant proportion of patients could not be started on anticoagulation because of bleeding complications. Left atrial appendage harbors clot in about 90% of nonvalvular AF. The advent of left atrial appendage occlusion (LAAO) techniques has provided these patients with alternative to OAC for stroke prophylaxis. Multiple LAAO devices are currently available with Watchman and Amulet being the most commonly used in clinical practice. Randomized studies are available for Watchman device only. Data on Amplatzer Cardiac Plug, Amulet and Lariat devices are limited by the paucity of randomized data. Long-term data on different LAAO techniques are showing promising results. Device related thrombosis continues to be a serious complication associated with LAAO. Future studies should look into comparative effectiveness between different LAAO techniques, optimal patient selection, risk of complications, and anticoagulant treatment after LAAO. This article aims to provide current available evidence on efficacy and safety of different LAAO devices and future prospective.
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Affiliation(s)
| | - Peter Park
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
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25
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Kleinecke C, Gomez Monterrosas O, Scalone G, Lam YY, Shin ES, Bellmann B, Brachmann J, Park JW. First-in-human experience of left atrial appendage occlusion with the steerable FuStar sheath. J Interv Cardiol 2018; 31:532-537. [PMID: 29582475 DOI: 10.1111/joic.12509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/25/2018] [Accepted: 03/01/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Due the wide variability of left atrial appendage morphology left atrial appendage occlusion (LAAO) remains a challenging procedure. The steerable FuStar delivery sheath was designed to allow both, transseptal access and delivery of percutaneous devices. We here report the first-in-human experience of LAAO with the FuStar sheath. METHODS Twenty patients (76.6 ± 8.4 years; 12 (60%) males; CHA2 DS2 -VASc score: 5.0 ± 2) with non-valvular fibrillation and contraindications to oral anticoagulation underwent LAAO with the LAmbre device using the FuStar steerable sheath (Lifetech Scientific Corp., Shenzhen, China) at two german centers. RESULTS Successful device implantation was achieved in all patients (100%). No periprocedural complications were observed. Procedure time, fluoroscopy time, contrast media, and radiation dose were 23.4 min ± 9.2, 11.9 min ± 4.1, 96.2 mL ± 45.7, and 2718.4 cG*cm2 ± 3835.3, respectively. CONCLUSION This study demonstrates the feasibility and safety of the steerable FuStar sheath for LAAO.
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Affiliation(s)
| | | | - Giancarla Scalone
- Department of Cardiology, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - Yat-Yin Lam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Eun-Seok Shin
- Department of Cardiology, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - Barbara Bellmann
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | | | - Jai-Wun Park
- Department of Cardiology, Klinikum Coburg, Coburg, Germany.,Department of Cardiology, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany.,Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
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Percutaneous left atrial appendage occlusion in the prevention of stroke in atrial fibrillation: a systematic review. Heart Fail Rev 2018; 23:191-208. [DOI: 10.1007/s10741-018-9681-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Tzikas A. Left Atrial Appendage Occlusion with Amplatzer Cardiac Plug and Amplatzer Amulet: a Clinical Trials Update. J Atr Fibrillation 2017; 10:1651. [PMID: 29487680 DOI: 10.4022/jafib.1651] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/19/2017] [Accepted: 11/14/2017] [Indexed: 12/13/2022]
Abstract
It has been over a decade since dedicated Amplatzer devices have been used for left atrial appendage occlusion (LAAO) in patients with atrial fibrillation. The first was the Amplatzer Cardiac Plug (ACP) that is now replaced in most countries by the Amplatzer Amulet device. Most of the clinical data for ACP come from the ACP multicenter registry that included 1047 patients from 22 sites, whereas the largest to date report on the Amplatzer Amulet is a recently published prospective multicenter study in 1088 patients from 64 sites. Two important randomized clinical trials the Amulet IDE trial and the STROKECLOSE trial are currently enrolling patients and expected to provide more data on LAAO with Amplatzer Amulet in the near future.
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Gloekler S, Hajredini B, Rycerz S, Jäckle S, Jung W. [Left atrial appendage clusure in nonvalvular atrial fibrillation : Clinical evidence 2017]. Herzschrittmacherther Elektrophysiol 2017; 28:366-380. [PMID: 29143099 DOI: 10.1007/s00399-017-0536-9] [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: 08/30/2017] [Accepted: 10/05/2017] [Indexed: 06/07/2023]
Abstract
Nonvalvular atrial fibrillation (AF) is the most common arrhythmia with a prevalence of 1-2% and affects approximately 15-20% of all octogenarians. Patients are at increased risk of thromboembolic stroke, with an overall risk of 5% per year. Thrombi form almost exclusively in the left atrial appendage (LAA), a blind sac-like heterogeneous structure trabeculated by pectinate muscles. In the past five decades, life-long oral anticoagulation (OAC) with vitamin K antagonists (VKA) has been the state-of-the art treatment to prevent stroke and systemic embolism from thrombi in AF. In the last decade, nonvitamin K dependent oral anticoagulants (NOAC) have been shown to be superior to VKA. Given the safety issues of indefinite OAC with either VKA or NOAC, it is plausible to consider left atrial appendage closure (LAAC) as an alternative strategy to prevent death, stroke or other systemic embolization, and bleeding. In recent years, LAAC has been compared to VKA in prospective randomized trials, yielding superior results regarding efficacy and noninferiority regarding safety in the mid-term. This review provides an update on the current state of LAAC in the field of prevention of death, stroke, and bleedings in patients suffering from nonvalvular AF. We elucidate the evidence and limitations of anticoagulation as the classical treatment paradigm, and review devices and techniques for LAAC. Most importantly, the current clinical evidence on efficacy and safety is outlined.
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Affiliation(s)
- Steffen Gloekler
- Klinik für Innere Medizin III, Kardiologie, Schwarzwald-Baar-Klinikum, 78052, Villingen-Schwenningen, Deutschland.
| | - Bajram Hajredini
- Klinik für Innere Medizin III, Kardiologie, Schwarzwald-Baar-Klinikum, 78052, Villingen-Schwenningen, Deutschland
| | - Simon Rycerz
- Klinik für Innere Medizin III, Kardiologie, Schwarzwald-Baar-Klinikum, 78052, Villingen-Schwenningen, Deutschland
| | - Sebastian Jäckle
- Klinik für Innere Medizin III, Kardiologie, Schwarzwald-Baar-Klinikum, 78052, Villingen-Schwenningen, Deutschland
| | - Werner Jung
- Klinik für Innere Medizin III, Kardiologie, Schwarzwald-Baar-Klinikum, 78052, Villingen-Schwenningen, Deutschland
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Gloekler S, Saw J, Koskinas KC, Kleinecke C, Jung W, Nietlispach F, Meier B. Left atrial appendage closure for prevention of death, stroke, and bleeding in patients with nonvalvular atrial fibrillation. Int J Cardiol 2017; 249:234-246. [DOI: 10.1016/j.ijcard.2017.08.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 01/06/2023]
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Affiliation(s)
- Lluis Asmarats
- From the Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Josep Rodés-Cabau
- From the Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
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de J Ramos Ramirez M, Young B, Harjai K, Mascarenhas V, Vijayaraman P. Left atrial appendage occlusion: 2016 in review. J Interv Cardiol 2017; 30:448-456. [PMID: 28799239 DOI: 10.1111/joic.12410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/09/2017] [Accepted: 07/10/2017] [Indexed: 01/14/2023] Open
Abstract
A significant body of data has emerged in the area of Percutaneous Left Atrial Appendage Occlusion (LAAO). In this article, we present an overview of the most notable publications along with a review of the most important publications on LAAO in 2016. We also present important historical data such as landmark clinical studies, review of most utilized occlusion devices, and important clinical studies that are underway.
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Affiliation(s)
| | - Bonnie Young
- Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania
| | - Kishore Harjai
- Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania
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Fastner C, Behnes M, Sartorius B, Wenke A, El-Battrawy I, Ansari U, Gill IS, Borggrefe M, Akin I. Procedural success and intra-hospital outcome related to left atrial appendage morphology in patients that receive an interventional left atrial appendage closure. Clin Cardiol 2017; 40:566-574. [PMID: 28409845 DOI: 10.1002/clc.22699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/31/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The interventional left atrial appendage (LAA) closure represents an emerging alternative to oral anticoagulation for stroke prevention in certain atrial fibrillation patients. Preliminary results have suggested high procedural success rates and fewer peri-interventional complications; however, there persists an insufficient understanding of the role of many underlying confounding variables (e.g., anatomical characteristics). HYPOTHESIS It was investigated whether varying LAA morphologies influence procedural success as well as in-hospital outcome. METHODS Sixty-seven patients ineligible for long-term oral anticoagulation were included in this single-center, prospective, observational registry spanning from the years 2014 to 2016. Interventions were performed with the Watchman occluder (Boston Scientific, Natick, MA) or the Amplatzer Amulet (St. Jude Medical, St. Paul, MN), at the operator's discretion. Results derived from the data describing procedural success, fluoroscopy, and peri-interventional safety events were classified according to the presenting LAA morphology (cauliflower, cactus, windsock, and chicken wing). RESULTS Rates of successful implantation were high across all groups (≥98%; P = 0.326). Surrogate parameters underlining procedural complexity like median total duration (P = 0.415), median fluoroscopy time (P = 0.459), median dose area product (P = 0.698), and the median amount of contrast agent (P = 0.076) demonstrated similar results across all groups. Likewise, the periprocedural complication rate was not significantly different and was mainly restricted to minor bleeding events. CONCLUSIONS Irrespective of the varying morphological presentation of the LAA, the procedural success rates, interventional characteristics, and safety events did not significantly differ among patients receiving an interventional LAA closure.
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Affiliation(s)
- Christian Fastner
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Benjamin Sartorius
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Annika Wenke
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ishar-Singh Gill
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Murarka S, Lazkani M, Moualla S, Verma DR, Pershad A. Left atrial anatomy and patient-related factors associated with adverse outcomes with the watchman device-a real world experience. J Interv Cardiol 2017; 30:163-169. [DOI: 10.1111/joic.12374] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/30/2017] [Accepted: 02/08/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Shishir Murarka
- Division of Interventional Cardiology; University of Arizona at Banner University Medical Center; Phoenix Arizona
| | - Mohamad Lazkani
- Division of Interventional Cardiology; University of Arizona at Banner University Medical Center; Phoenix Arizona
| | - Soundos Moualla
- Division of Interventional Cardiology; University of Arizona at Banner University Medical Center; Phoenix Arizona
| | - Divya Ratan Verma
- Division of Interventional Cardiology; University of Arizona at Banner University Medical Center; Phoenix Arizona
| | - Ashish Pershad
- Division of Interventional Cardiology; University of Arizona at Banner University Medical Center; Phoenix Arizona
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BELLMANN BARBARA, SCHNUPP STEFFEN, KÜHNLEIN PETER, JAVERNIK CHRISTIAN, KLEINECKE CAROLINE, RILLIG ANDREAS, LANDMESSER ULF, BRACHMANN JOHANNES, PARK JAIWUN. Left Atrial Appendage Closure With the New Occlutech® Device: First in Man Experience and Neurological Outcome. J Cardiovasc Electrophysiol 2016; 28:315-320. [DOI: 10.1111/jce.13141] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 12/24/2022]
Affiliation(s)
- BARBARA BELLMANN
- Department of Cardiology, Campus Benjamin Franklin; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - STEFFEN SCHNUPP
- Department of Cardiology; Hospital Klinikum Coburg; Coburg Germany
| | - PETER KÜHNLEIN
- Department of Neurology; Hospital Klinikum Coburg; Coburg Germany
| | | | | | - ANDREAS RILLIG
- Department of Cardiology, Campus Benjamin Franklin; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - ULF LANDMESSER
- Department of Cardiology, Campus Benjamin Franklin; Charité-Universitätsmedizin Berlin; Berlin Germany
| | | | - JAI-WUN PARK
- Department of Cardiology, Campus Benjamin Franklin; Charité-Universitätsmedizin Berlin; Berlin Germany
- Department of Cardiology; Hospital Klinikum Coburg; Coburg Germany
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Reply: Complicated and Impractical Classification of LAA Morphologies: How to Relate to LAA Closure Procedures? JACC Cardiovasc Interv 2016; 9:2177-2178. [PMID: 27765320 DOI: 10.1016/j.jcin.2016.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 11/20/2022]
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Complicated and Impractical Classification of LAA Morphologies. JACC Cardiovasc Interv 2016; 9:2176-2177. [DOI: 10.1016/j.jcin.2016.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 11/18/2022]
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Turi ZG. Lessons From Drive-By Left Atrial Appendage Occlusion. JACC Cardiovasc Interv 2016; 9:1384-5. [DOI: 10.1016/j.jcin.2016.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 11/16/2022]
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