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Lee WC, Chang WT, Shih JY, Wu PJ, Fang CY, Chen HC, Fang YN, Fang HY. Impact of chronic kidney disease on left atrial appendage occlusion: A meta-analysis of procedural outcomes and complications. Medicine (Baltimore) 2024; 103:e38935. [PMID: 39029071 PMCID: PMC11398750 DOI: 10.1097/md.0000000000038935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) experience atrial fibrillation more frequently. The balance of medical management for stroke prevention and bleeding events presents a challenging issue in CKD population. Left atrial appendage occlusion (LAAO) may be an effective solution for stroke prevention in patients who experience frequent bleeding with oral anticoagulants. However, the specific impact of CKD on the procedural success, complications, and outcomes of LAAO implantations remains underexplored. METHODS We conducted a search of various databases for articles published before October 31, 2023. This search yielded 7 studies, comparing outcomes between CKD and non-CKD cohorts undergoing LAAO implantation. Our analysis focused on CHA2DS2-VASc scores, average eGFR, use of oral anticoagulants, procedural success rates, procedural complications, and associated outcomes. RESULTS The meta-analysis included data from 2576 patients, with 1131 identified as having CKD. The CKD group also had higher CHA2DS2-VASc scores (4.7 ± 1.4 vs 4.0 ± 1.5; P < .001) and HAS-BLED scores (3.8 ± 1.1 vs 3.1 ± 1.0; P < .001) than the non-CKD group. CKD patients showed a nonreduction in procedural success rates and a nonsignificant increase in total complications. The risks of stroke and transient ischemic attack, major bleeding, and cardiovascular mortality were not significantly different between the 2 groups. However, a significantly lower rate of total mortality was observed in the non-CKD group (odds ratio: 0.43; 95% confidence interval, 0.32-0.60). CONCLUSION While CKD is associated with a nonsignificant decrease in procedural success and a nonsignificant increase in complication risks, the outcomes of LAAO implantation are comparably favorable between CKD and non-CKD groups. Despite similar procedural outcomes, the CKD group exhibited a higher rate of all-cause mortality.
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Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Jhih-Yuan Shih
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Po-Jui Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Nan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Jen-Ai Hospital, Taichung, Taiwan
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Helal B, Khan J, AlJayar D, Khan MS, Alabdaljabar MS, Asad ZUA, DeSimone CV, Deshmukh A. Risk factors, clinical implications, and management of peridevice leak following left atrial appendage closure: A systematic review. J Interv Card Electrophysiol 2024; 67:865-885. [PMID: 38182966 DOI: 10.1007/s10840-023-01729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/26/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Left atrial appendage closure (LAAC) is a treatment modality for stroke prevention in patients with atrial fibrillation (AF). One of the potential complications of LAAC is a peri-device leak (PDL), which could potentially increase the risk of thromboembolism formation. METHODS This systematic review was done according to PRISMA guidelines. Using four databases, all primary studies through April 2022 that met selection criteria were included. Outcomes of interest were studies reporting on PDL characteristics, risk factors and management. RESULTS A total of 116 studies met selection criteria (97 original studies and 19 case reports/series). In the original studies (n = 30,133 patients), the weighted mean age was 72.0 ± 7.4 years (57% females) with a HAS-BLED and CHA2DS2-VASc weighted means of 2.8 ± 1.1 and 3.8 ± 1.3, respectively. The most common definition of PDL was based on size; 5 mm: major, 3-5 mm: moderate, < 1 mm minor, or trivial. Follow up time for PDL detection was 7.15 ± 9.0 months. 33% had PDL, irrespective of PDL severity/size, and only 0.9% had PDL of greater than 5 mm. The main risk factors for PDL development included lower degree of over-sizing, lower left ventricular ejection fraction, device/LAA shape mismatch, previous radiofrequency ablation, and male sex. The most common methods to screen for PDL included transesophageal echocardiogram and cardiac CT. PDL Management approaches include Amplatzer Patent Foramen Ovale occluder, Hookless ACP, Amplatzer vascular plug II, embolic coils, and detachable vascular coils; removal or replacement of the device; and left atriotomy. CONCLUSION Following LAAC, the emergence of a PDL is a significant complication to be aware of. Current evidence suggests possible risk factors that are worth assessing in-depth. Additional research is required to assess suitable candidates, timing, and strategies to managing patients with PDL.
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Affiliation(s)
- Baraa Helal
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Jibran Khan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Dalia AlJayar
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, 200 1St Street SW, Rochester, MN, 55905, USA.
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Mahmoudi K, Galea R, Elhadad S, Temperli F, Sebag F, Gräni C, Rezine Z, Roten L, Landolff Q, Brugger N, Masri A, Räber L, Amabile N. Computed Tomography Scan Evidence for Left Atrial Appendage Short-Term Remodeling Following Percutaneous Occlusion: Impact of Device Oversizing. J Am Heart Assoc 2023; 12:e030037. [PMID: 37609989 PMCID: PMC10547351 DOI: 10.1161/jaha.123.030037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023]
Abstract
Background The interrelationships between left atrial appendage (LAA) dimensions and device following implantation are unknown. We aimed to analyze the impact of Watchman device implantation on LAA dimensions following its percutaneous closure and potential predictors of remodeling. Methods and Results All consecutive LAA closure procedures performed at 2 centers between November 2017 and December 2020 were included in the WATCH-DUAL (Watchman 2.5 Versus Watchman FLX in a Dual-Center Left Atrial Appendage Closure Cohort) registry. This study included patients who had pre- and postintervention computed tomography scan analysis. The LAA and device dimensions were measured in a centralized core lab by 3-dimensional computed tomography scan reconstruction methods, focusing on the device landing zone. This analysis included 104 patients (age, 76.0 [range, 72.0-83.0] years; 72% men; 53% Watchman FLX; 47% Watchman 2.5). The baseline characteristics were comparable between Watchman 2.5 and Watchman FLX groups, except for the higher use of oversizing in the latter group. The median delay for computed tomography control was 49 (range, 43-64) days. The landing zone area (median, 446 [range, 363-523] versus 290 [222-366] mm2; P<0.001) and minimal diameter (median, 23.0 [range, 20.7-24.8] versus 16.7 [14.7-19.4] mm; P<0.001) significantly increased after implantation. The absolute (median, 157 [range, 98-220] versus 85 [18-148] mm2, P<0.001) and relative (median, 50% [range, 32%-79%] versus 26% [4%-50%]; P<0.001) increases in landing zone area were more pronounced in patients with oversized device. Baseline LAA dimensions were smaller, landing zone eccentricity larger, and oversized device more frequent in patients with significant overexpansion compared with the others. Conclusions LAA dimensions increased at the site of the Watchman prosthesis after implantation, suggesting a local positive remodeling after the procedure. This phenomenon was more pronounced in the case of oversized devices.
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Affiliation(s)
- Khalil Mahmoudi
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
| | - Roberto Galea
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Simon Elhadad
- Cardiology Department, Centre Hospitalier Marne la Vallée, JossignyFrance
| | - Fabrice Temperli
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Frederic Sebag
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
| | - Christoph Gräni
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Zhor Rezine
- Cardiology Department, Centre Hospitalier Marne la Vallée, JossignyFrance
| | - Laurent Roten
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | | | - Nicolas Brugger
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Alaa Masri
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
| | - Lorenz Räber
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Nicolas Amabile
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
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Theofilis P, Oikonomou E, Antonopoulos AS, Siasos G, Tsioufis K, Tousoulis D. Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives. Biomedicines 2022; 10:2268. [PMID: 36140368 PMCID: PMC9496262 DOI: 10.3390/biomedicines10092268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/03/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, represents a major cause of morbidity and mortality, with an increasing prevalence. Pharmacologic treatment remains the cornerstone of its management through rhythm and rate control, as well as the prevention of thromboembolism with the use of oral anticoagulants. Recent progress in percutaneous interventional approaches have provided additional options in the therapeutic arsenal, however. The use of the different catheter ablation techniques can now lead to long arrhythmia-free intervals and significantly lower AF burden, thus reducing the rate of its complications. Particularly encouraging evidence is now available for patients with persistent AF or concomitant heart failure, situations in which catheter ablation could even be a first-line option. In the field of stroke prevention, targeting the left atrial appendage with percutaneous device implantation may reduce the risk of thromboembolism to lower rates than that predicted with conventional ischemic risk scores. Left atrial appendage occlusion through the approved Watchman or Amplatzer devices is a well-established, efficacious, and safe method, especially in high-ischemic and bleeding risk patients with contraindications for oral anticoagulation.
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Affiliation(s)
- Panagiotis Theofilis
- First Department of Cardiology, “Hippokration” General Hospital, University of Athens Medical School, 11527 Athens, Greece
| | - Evangelos Oikonomou
- Third Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, University of Athens Medical School, 11527 Athens, Greece
| | - Alexios S. Antonopoulos
- First Department of Cardiology, “Hippokration” General Hospital, University of Athens Medical School, 11527 Athens, Greece
| | - Gerasimos Siasos
- Third Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, University of Athens Medical School, 11527 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, “Hippokration” General Hospital, University of Athens Medical School, 11527 Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, “Hippokration” General Hospital, University of Athens Medical School, 11527 Athens, Greece
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5
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Da-Wariboko A, Lin HC, Valderrábano M. Simultaneous repair of left atrial appendage perforation and appendage closure by trans-atrial deployment of a septal occluder device: preclinical and clinical validation. Heart Rhythm 2022; 19:1022-1030. [PMID: 35032669 DOI: 10.1016/j.hrthm.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 11/26/2022]
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6
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Murtaza G, Yarlagadda B, Akella K, Della Rocca DG, Gopinathannair R, Natale A, Lakkireddy D. Role of the Left Atrial Appendage in Systemic Homeostasis, Arrhythmogenesis, and Beyond. Card Electrophysiol Clin 2021; 12:21-28. [PMID: 32067644 DOI: 10.1016/j.ccep.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The left atrial appendage (LAA) affects body homeostasis via atrial natriuretic peptide and the renin-angiotensin-aldosterone system and plays an important role in atrial compliance. Approximately 90% of clots in nonvalvular atrial fibrillation (AF) are formed in the LAA. AF is the most common sustained cardiac arrhythmia and is frequently associated with stroke. Because anticoagulation for stroke prophylaxis carries a higher bleeding risk, LAA closure via epicardial and endocardial approaches has gained popularity and is being increasingly pursued for arrhythmogenic, homeostatic, and stroke-reduction benefits. This review discusses the homeostatic role of the LAA and its involvement in arrhythmogenesis and thrombus formation.
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Affiliation(s)
- 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
| | - Bharath Yarlagadda
- Division of Cardiology, Department of Internal Medicine, MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - 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
| | - 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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7
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Wunderlich NC, Lorch GC, Honold J, Franke J, Küx H. Why Follow-up Examinations After Left Atrial Appendage Closure Are Important: Detection of Complications During Follow-up and How to Deal with Them. Curr Cardiol Rep 2020; 22:113. [PMID: 32770393 DOI: 10.1007/s11886-020-01357-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Device-related thrombus (DRT) formation and incomplete left atrial appendage closure (LAAC) are the two major complications that can occur after LAAC and can potentially limit the success of such a procedure. This review discusses the incidence, clinical and/or prognostic significance, detection methods, treatment options, and potential strategies to prevent these complications. RECENT FINDINGS It has recently been proven that the presence of a DRT represents an independent predictor for ischemic stroke after LAAC. Continued need for anticoagulation due to incomplete LAAC is clinically relevant to the patient. The appearances of a DRT or an incompletely closed LAA after a LAAC procedure are not rare complications. Due to the clinical and/or prognostic significance of these complications, it is important to detect them in a timely manner during follow-up by using the appropriate diagnostic imaging techniques. Since a DRT is associated with an increased risk of stroke, the therapy should be aggressive. In the case of incomplete LAA closure, an additional closure device may be used to complete occlusion and avoid lifelong anticoagulation therapy.
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Affiliation(s)
- Nina C Wunderlich
- Cardiovascular Center Darmstadt, Dieburgerstrasse 31c, 64287, Darmstadt, Germany.
| | - Gabriele C Lorch
- Cardiovascular Center Darmstadt, Dieburgerstrasse 31c, 64287, Darmstadt, Germany
| | - Jörg Honold
- Cardiovascular Center Darmstadt, Dieburgerstrasse 31c, 64287, Darmstadt, Germany
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany
| | - Jennifer Franke
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Harald Küx
- Cardiovascular Center Darmstadt, Dieburgerstrasse 31c, 64287, Darmstadt, Germany
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8
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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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9
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Correlation between LAA Morphological Features and Computational Fluid Dynamics Analysis for Non-Valvular Atrial Fibrillation Patients. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10041448] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The left atrial appendage (LAA) is a complex cardiovascular structure which can yield to thrombi formation in patients with non-valvular atrial fibrillation (AF). The study of LAA fluid dynamics together with morphological features should be investigated in order to evaluate the possible connection of geometrical and hemodynamics indices with the stroke risk. To reach this goal, we conducted a morphological analysis of four different LAA shapes considering their variation during the cardiac cycle and computational fluid dynamics (CFD) simulations in AF conditions were carried out. The analysis of main geometrical LAA parameters showed a huger ostium and a reduced motility for the cauliflower and cactus shapes, as well as a lower velocity values from the CFD analysis. Such findings are in line with literature and highlight the importance of coupling dynamics imaging data with CFD calculations for providing information not available at clinical level.
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10
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Tan NY, Yasin OZ, Sugrue A, El Sabbagh A, Foley TA, Asirvatham SJ. Anatomy and Physiologic Roles of the Left Atrial Appendage: Implications for Endocardial and Epicardial Device Closure. Interv Cardiol Clin 2019. [PMID: 29526287 DOI: 10.1016/j.iccl.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The left atrial appendage has been implicated as a major nidus for thrombus formation, particularly in atrial fibrillation. This discovery has prompted substantial interest in the development of left atrial appendage exclusion devices aimed at decreasing systemic thromboembolism risk. Its deceptively simple appearance belies the remarkable complexity that characterizes its anatomy and physiology. We highlight the key anatomic features and variations of the left atrial appendage as well as its relationships with surrounding structures. We also summarize crucial anatomic factors that should be taken into account by the interventional cardiologist when planning for or performing left atrial appendage exclusion procedures.
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Affiliation(s)
- Nicholas Y Tan
- Department of Internal Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Omar Z Yasin
- Department of Internal Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Alan Sugrue
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Thomas A Foley
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN 55905, USA.
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11
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Sex Differences in Atrial Fibrillation—Update on Risk Assessment, Treatment, and Long-Term Risk. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:79. [DOI: 10.1007/s11936-018-0682-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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12
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Turagam M, Atkins D, Earnest M, Lee R, Nath J, Ferrell R, Bartus K, Badhwar N, Rasekh A, Cheng J, Di Biase L, Natale A, Wilber D, Lakkireddy D. Anatomical and electrical remodeling with incomplete left atrial appendage ligation: Results from the LAALA-AF registry. J Cardiovasc Electrophysiol 2017; 28:1433-1442. [DOI: 10.1111/jce.13343] [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: 06/15/2017] [Revised: 07/25/2017] [Accepted: 08/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Mohit Turagam
- Division of Cardiovascular Medicine; University of Missouri Hospital and Clinics; Columbia MO USA
| | - Donita Atkins
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Matthew Earnest
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Randall Lee
- Section of Electrophysiology; UCSF Medical Center; San Francisco CA USA
| | - Jayant Nath
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Ryan Ferrell
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | | | - Nitish Badhwar
- Section of Electrophysiology; UCSF Medical Center; San Francisco CA USA
| | - Abdi Rasekh
- Baylor St. Luke's Medical Center; Houston TX USA
| | - Jie Cheng
- Texas Heart Institute; Houston TX USA
| | - Luigi Di Biase
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
| | - Andrea Natale
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
| | - David Wilber
- Division of Cardiovascular Medicine; Loyola University Medical Center; Chicago IL USA
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
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13
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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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14
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Abstract
Incomplete left atrial appendage closure (LAAC) occurs in ∼30-40 % of cases following both surgical and percutaneous closure methods. Incomplete surgical LAAC may further be classified as incompletely surgically ligated LAA (ISLL) or LAA stump. ISLL is associated with a significantly increased risk of thrombus formation/thromboembolism. Moreover, this risk is highest in the absence of oral anticoagulation (OAC) and inversely correlates with the size of the ISLL neck. Not only routine screening for ISLL seems critical, but also long-term OAC should strongly be considered in this high-risk cohort. Alternatively, complete endocardial occlusion using a surrogate method may represent a reasonable option, particularly in those intolerant to long-term OAC therapy. Although thrombus formation/thromboembolic events have also been described in patients with incomplete LAAC following percutaneous occlusion, an association between the two remains less clear. However, given the rise and growing interest in percutaneous LAAC methods, additional research in this area is clearly warranted.
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Affiliation(s)
- Arash Aryana
- Mercy Medical Group and Dignity Health Heart and Vascular Institute, Sacramento, CA, USA.
| | - André d'Avila
- Instituto de Pesquisa em Arritmia Cardiaca, Hospital Cardiologico, Florianopolis, Santa Catarina, Brazil
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15
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Lee RJ. Clinical Significance of Leaks Following Left Atrial Appendage Ligation With the LARIAT Suture Delivery Device. JACC Cardiovasc Interv 2016; 9:1058-60. [PMID: 27198687 DOI: 10.1016/j.jcin.2016.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Randall J Lee
- Department of Medicine, Cardiovascular Research Institute, and Institute for Regeneration Medicine, University of California-San Francisco, San Francisco, California.
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