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Galea R, Räber L. Antithrombotic Therapy in Patients Undergoing Percutaneous Left Atrial Appendage Occlusion. Interv Cardiol Clin 2024; 13:543-552. [PMID: 39245553 DOI: 10.1016/j.iccl.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
Percutaneous left atrial appendage closure (LAAC) is a valid alternative to oral anticoagulation to prevent ischemic stroke in patients with atrial fibrillation.The devices approved in Europe and United States for percutaneous LAAC contain metal and temporary antithrombotic therapy is strongly recommended following implantation to prevent thrombus formation on the atrial device surface. There is still uncertainty regarding to the optimal antithrombotic drug regimen after device implantation for several reasons. Thus, this review aims at summarizing the available evidence and the remaining challenges related to the management of antithrombotic therapy in the context of LAAC procedure.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. https://twitter.com/RaberLorenz
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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2
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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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3
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Kramer A, Korsholm K, Nielsen-Kudsk JE. Single antiplatelet therapy following Amplatzer left atrial appendage occlusion. EUROINTERVENTION 2024; 20:e301-e311. [PMID: 38436367 PMCID: PMC10905198 DOI: 10.4244/eij-d-23-00684] [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] [Received: 08/16/2023] [Accepted: 12/04/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND The optimal antithrombotic therapy following left atrial appendage occlusion (LAAO) remains debated. Ideally, this therapy should effectively prevent device-related thrombosis (DRT) while minimising the associated bleeding risk. AIMS We aimed to evaluate the long-term safety and efficacy of a postprocedural single antiplatelet therapy (SAPT) strategy following Amplatzer LAAO in a large consecutive cohort. METHODS This retrospective, single-centre, observational study included all patients discharged on SAPT after LAAO with the Amplatzer Cardiac Plug (ACP) or Amplatzer Amulet between March 2010 and December 2021 at Aarhus University Hospital, Denmark. Baseline, procedural, and imaging data were obtained locally, while clinical outcomes and medication data were extracted from the Danish national health registries. RESULTS A total of 553 patients underwent Amplatzer LAAO during the specified time frame. Of these, 431 (77.9%) high bleeding risk patients were discharged on SAPT with either acetylsalicylic acid (n=403, 72.9%) or clopidogrel (n=28, 5.1%). At 6 months, 173 (41.7%) patients were not on any antithrombotic therapy. The mean CHA2DS2-VASc and HAS-BLED scores were 3.9±1.5 and 3.4±1.1, respectively. DRT was detected in 6 (1.5%) patients on 8-week follow-up imaging using cardiac computed tomography (n=386, 89.6%) or transoesophageal echocardiography (n=27, 6.3%). The 1-year ischaemic stroke rate was 2.2% (95% confidence interval [CI]: 1.1-4.2). One-year rates for major bleeding and cardiovascular death were 5.9% (95% CI: 4.0-8.9) and 2.9% (95% CI: 1.6-5.1), respectively. CONCLUSIONS SAPT following Amplatzer LAAO displayed rates of DRT and stroke comparable to those reported with more intensive antithrombotic regimens. Meanwhile, we observed low rates of major bleeding.
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Affiliation(s)
- Anders Kramer
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Erik Nielsen-Kudsk
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Alkhouli M, Freeman JV, Ellis CR, Shah AP, Gada H, Coylewright M, Lo M, Makkar A, Agarwal H, Lakkireddy D. First Experience With Amulet in the United States: Early Insights From EMERGE LAA Postapproval Study. JACC Cardiovasc Interv 2024:S1936-8798(23)01553-4. [PMID: 38310499 DOI: 10.1016/j.jcin.2023.11.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND The Food and Drug Administration approved the Amulet occluder (Abbott) after demonstrating safety and effectiveness in the Amulet IDE (AMPLATZER Amulet LAA Occluder) trial. OBJECTIVES The aim of the EMERGE Left Atrial Appendage study is to evaluate early postapproval outcomes of the Amulet occluder in the United States using data from the National Cardiovascular Data Registry Left Atrial Appendage Occlusion Registry. METHODS Patients with a commercial Amulet occluder implant attempt between Food and Drug Administration approval (August 14, 2021) and December 31, 2022, were included. The safety composite endpoint included all-cause death, ischemic stroke, systemic embolism, or device/procedure-related events requiring open cardiac surgery or endovascular intervention between device implantation and 7 days or hospital discharge (whichever is later). Major adverse events through 45 days were also reported and stratified by operator experience (early [<10 cases], moderate [10-29 cases], and high [30+ cases]). RESULTS A total of 5,499 patients underwent attempted Amulet occluder implantation. Implant success was 95.8%, and complete closure was 97.2% post-left atrial appendage occlusion and 87.1% at 45 days. A safety composite endpoint event occurred in 0.76% patients. Any major adverse event occurred in 2.9% and 5.7% of patients in-hospital and through 45 days, respectively, driven by major bleeding and pericardial effusion (PE) requiring intervention. PE requiring surgery or percutaneous intervention decreased significantly with increasing experience both in-hospital (early vs high operator experience 1.8% vs 1.1%; P = 0.006) and at 45 days (2.3% vs 1.5%; P = 0.012). CONCLUSIONS The EMERGE Left Atrial Appendage study demonstrates favorable safety and effectiveness of the Amulet occluder in the real-world setting. More experienced operators had improved implant success and fewer PEs, suggesting a learning curve effect implanting this dual occlusive mechanism device.
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Affiliation(s)
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Atman P Shah
- The University of Chicago, Chicago, Illinois, USA
| | - Hemal Gada
- University of Pittsburgh Medical Center, Wormleysburg, Pennsylvania, USA
| | - Megan Coylewright
- Erlanger and University of Tennessee Health Science Center, College of Medicine, Chattanooga, Tennessee
| | - Monica Lo
- Arkansas Heart Hospital, Little Rock, Arkansas, USA
| | - Akash Makkar
- Arizona Heart Arrhythmia Associates, Phoenix, Arizona, USA
| | - Himanshu Agarwal
- CHI Creighton University School of Medicine, Bergan Mercy Hospital, Omaha, Nebraska, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
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Nitta T, Wai JWW, Lee SH, Yii M, Chaiyaroj S, Ruaengsri C, Ramanathan T, Ishii Y, Jeong DS, Chang J, Hardjosworo ABA, Imai K, Shao Y. 2023 APHRS expert consensus statements on surgery for AF. J Arrhythm 2023; 39:841-852. [PMID: 38045465 PMCID: PMC10692856 DOI: 10.1002/joa3.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
| | | | - Seung Hyun Lee
- Cardiovascular SurgeryYonsei University College of MedicineSeoulSouth Korea
| | - Michael Yii
- Cardiothoracic Surgery, Epworth Eastern Hospital, and St Vincent's Hospital MelbourneUniversity of MelbourneMelbourneVictoriaAustralia
| | | | | | | | - Yosuke Ishii
- Cardiovascular SurgeryNippon Medical SchoolTokyoJapan
| | - Dong Seop Jeong
- Thoracic and Cardiovascular Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Jen‐Ping Chang
- Thoracic and Cardiovascular SurgeryKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
| | | | - Katsuhiko Imai
- Heart Center of National Hospital Organization Kure Medical Center and Chugoku Cancer CenterKure, HiroshimaJapan
| | - Yongfeng Shao
- Cardiovascular Surgery, Jiangsu Province HospitalNanjing Medical UniversityNanjingChina
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Nagasaka T, Nakamura M. Left Atrial Appendage Closure: A Narrative Review. Cardiol Ther 2023; 12:615-635. [PMID: 37938523 DOI: 10.1007/s40119-023-00337-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and the cause of thromboembolic events in elderly patients worldwide. AF is associated with a significantly increased risk of morbidity and mortality due to cardiac emboli, primarily from left atrial appendage (LAA) thrombus. Oral anticoagulation therapy is the standard treatment to effectively reduce the risk of thromboembolic events in patients with AF. However, anticoagulation treatment increases bleeding risk. LAA closure (LAAC) has recently been introduced as a feasible mechanical preventive intervention for thromboembolic events while minimizing the risk of bleeding. Transcatheter LAAC devices have evolved in the past decade, and several ongoing trials have demonstrated the improvements of safety and outcomes in newer generation devices. This review summarizes the current perspectives and outcomes regarding LAAC as an alternative to pharmacologic therapy.
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Affiliation(s)
- Takashi Nagasaka
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Mamoo Nakamura
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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7
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Cundari G, Alkadhi H, Eberhard M. The role of CT in arrhythmia management-treatment planning and post-procedural imaging surveillance. Br J Radiol 2023; 96:20230028. [PMID: 37191058 PMCID: PMC10607403 DOI: 10.1259/bjr.20230028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/21/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Several interventional treatment options exist in patients with atrial and ventricular arrhythmia. Cardiac CT is routinely performed prior to occlusion of the left atrial appendage, pulmonary vein isolation, and cardiac device implantation. Besides the evaluation of coronary artery disease, cardiac CT provides isotropic, high-resolution CT images of the cardiac anatomy with the possibility of multiplanar reformations and three-dimensional reconstructions which are helpful to guide interventional treatment. In addition, cardiac CT is increasingly used to rapidly evaluate periprocedural complications and for the routine post-procedural imaging surveillance in patients after interventions. This review article will discuss current applications of pre- and post-interventional CT imaging in patients with arrhythmia.
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Affiliation(s)
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Jimenez Diaz VA, Kapadia SR, Linke A, Mylotte D, Lansky AJ, Grube E, Settergren M, Puri R. Cerebral embolic protection during transcatheter heart interventions. EUROINTERVENTION 2023; 19:549-570. [PMID: 37720969 PMCID: PMC10495748 DOI: 10.4244/eij-d-23-00166] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/17/2023] [Indexed: 09/19/2023]
Abstract
Stroke remains a devastating complication of transcatheter aortic valve replacement (TAVR), with the incidence of clinically apparent stroke seemingly fixed at around 3% despite TAVR's significant evolution during the past decade. Embolic showers of debris (calcium, atheroma, valve material, foreign material) are captured in the majority of patients who have TAVR using a filter-based cerebral embolic protection device (CEPD). Additionally, in systematic brain imaging studies, the majority of patients receiving TAVR exhibit new cerebral lesions. Mechanistic studies have shown reductions in the volume of new cerebral lesions using CEPDs, yet the first randomised trial powered for periprocedural stroke within 72 hours of a transfemoral TAVR failed to meet its primary endpoint of showing superiority of the SENTINEL CEPD. The present review summarises the clinicopathological rationale for the development of CEPDs, the evidence behind these devices to date and the emerging recognition of cerebral embolisation in many non-TAVR transcatheter procedures. Given the uniqueness of each of the various CEPDs under development, specific trials tailored to their designs will need to be undertaken to broaden the CEPD field, in addition to evaluating the role of CEPD in non-TAVR transcatheter heart interventions. Importantly, the cost-effectiveness of these devices will require assessment to broaden the adoption of CEPDs globally.
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Affiliation(s)
- Victor Alfonso Jimenez Diaz
- Cardiology Department, Hospital Álvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IISGS), SERGAS-UVIGO, Vigo, Spain
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Heart Center Dresden University Hospital, Dresden, Germany and Technische Universität Dresden, Dresden, Germany
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland and University of Galway, Galway, Ireland
| | | | - Eberhard Grube
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Magnus Settergren
- Heart and Vascular Unit, Karolinska University Hospital, Stockholm, Sweden and Karolinska Institutet, Stockholm, Sweden
| | - Rishi Puri
- Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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9
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Jiang H, Koh TH, Vengkat V, Fei G, Ding ZP, Ewe SH, Jappar I, Lim ST, Yap J. An Updated Meta-Analysis on the Clinical Outcomes of Percutaneous Left Atrial Appendage Closure Versus Direct Oral Anticoagulation in Patients With Atrial Fibrillation. Am J Cardiol 2023; 200:135-143. [PMID: 37321026 DOI: 10.1016/j.amjcard.2023.05.044] [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] [Received: 03/03/2023] [Revised: 04/09/2023] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
The availability of direct oral anticoagulants (DOACs) with known lower bleeding risk compared with warfarin have raised questions about the role of left atrial appendage closure (LAAC). We aimed to perform a meta-analysis to compare the clinical outcomes for LAAC versus DOACs. All studies directly comparing LAAC with DOACs up to January 2023 were included. The outcomes studied included the combined major adverse cardiovascular (CV) events outcomes, ischemic stroke and thromboembolic events, major bleeding, CV mortality, and all-cause mortality. Hazard ratios (HRs) and their 95% confidence interval were extracted or estimated from the data and pooled together with a random-effects model. A total of 7 studies (1 randomized controlled trial, 6 propensity-matched observational studies) were finally included, with a pooled population of 4,383 patients who underwent LAAC and 4,554 patients on DOACs. There were no significant differences between patients who underwent LAAC and patients on DOACs in terms of baseline age (75.0 vs 74.7, p = 0.27), CHA2DS2-VASc score (5.1 vs 5.1, p = 0.33), or HAS-BLED score (3.3 vs 3.3, p = 0.36). After a mean weighted follow-up of 22.0 months, LAAC was associated with significantly lower rates of combined major adverse CV event outcomes (HR 0.73 [0.56 to 0.95], p = 0.02), all-cause mortality (HR 0.68 [0.54 to 0.86], p = 0.02), and CV mortality (HR 0.55 [0.41 to 0.72], p<0.01). There were no significant differences in the rates of ischemic stroke or systemic embolism (HR 1.12 [0.92 to 1.35], p = 0.25), major bleeding (HR 0.94 [0.67 to 1.32], p = 0.71), or hemorrhagic stroke (HR 1.07 [0.74 to 1.54], p = 0.74) between LAAC and DOAC. In conclusion, percutaneous LAAC was found to be as efficacious as DOACs for stroke prevention, with lower all-cause and CV mortality. The rates of major bleeding and hemorrhagic stroke were similar. LAAC has a potential role to play in stroke prevention in patients with atrial fibrillation in the era of DOACs, but further randomized data are needed.
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Affiliation(s)
- Haowen Jiang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Cardiology, National Heart Center Singapore, Singapore
| | - Tian Hai Koh
- Department of Cardiology, National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Vijay Vengkat
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Gao Fei
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Zee Pin Ding
- Department of Cardiology, National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - See Hooi Ewe
- Department of Cardiology, National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Ignasius Jappar
- Department of Cardiology, National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Soo Teik Lim
- Department of Cardiology, National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Jonathan Yap
- Department of Cardiology, National Heart Center Singapore, Singapore; Duke-NUS Medical School, Singapore.
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10
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Saw J, Holmes DR, Cavalcante JL, Freeman JV, Goldsweig AM, Kavinsky CJ, Moussa ID, Munger TM, Price MJ, Reisman M, Sherwood MW, Turi ZG, Wang DD, Whisenant BK. SCAI/HRS Expert Consensus Statement on Transcatheter Left Atrial Appendage Closure. JACC Cardiovasc Interv 2023; 16:1384-1400. [PMID: 36990858 DOI: 10.1016/j.jcin.2023.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Exclusion of the left atrial appendage to reduce thromboembolic risk related to atrial fibrillation was first performed surgically in 1949. Over the past 2 decades, the field of transcatheter endovascular left atrial appendage closure (LAAC) has rapidly expanded, with a myriad of devices approved or in clinical development. The number of LAAC procedures performed in the United States and worldwide has increased exponentially since the Food and Drug Administration approval of the WATCHMAN (Boston Scientific) device in 2015. The Society for Cardiovascular Angiography & Interventions (SCAI) has previously published statements in 2015 and 2016 providing societal overview of the technology and institutional and operator requirements for LAAC. Since then, results from several important clinical trials and registries have been published, technical expertise and clinical practice have matured over time, and the device and imaging technologies have evolved. Therefore, SCAI prioritized the development of an updated consensus statement to provide recommendations on contemporary, evidence-based best practices for transcatheter LAAC focusing on endovascular devices.
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Affiliation(s)
- Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada.
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic Health System Rochester, Rochester, Minnesota
| | - João L Cavalcante
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, The University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Issam D Moussa
- Carle Heart and Vascular Institute, Carle Illinois College of Medicine, Urbana, Illinois
| | - Thomas M Munger
- Department of Cardiovascular Medicine, Mayo Clinic Health System Rochester, Rochester, Minnesota
| | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Green Hospital, La Jolla, California
| | - Mark Reisman
- Division of Cardiology, Weill Cornell Medical Center, New York, New York
| | | | - Zoltan G Turi
- Center for Structural and Congenital Heart Disease, Hackensack University Medical Center, Hackensack, New Jersey
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
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11
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Saw J, Holmes DR, Cavalcante JL, Freeman JV, Goldsweig AM, Kavinsky CJ, Moussa ID, Munger TM, Price MJ, Reisman M, Sherwood MW, Turi ZG, Wang DD, Whisenant BK. SCAI/HRS Expert Consensus Statement on Transcatheter Left Atrial Appendage Closure. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100577. [PMID: 39130704 PMCID: PMC11307869 DOI: 10.1016/j.jscai.2022.100577] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Exclusion of the left atrial appendage to reduce thromboembolic risk related to atrial fibrillation was first performed surgically in 1949. Over the past 2 decades, the field of transcatheter endovascular left atrial appendage closure (LAAC) has rapidly expanded, with a myriad of devices approved or in clinical development. The number of LAAC procedures performed in the United States and worldwide has increased exponentially since the Food and Drug Administration approval of the WATCHMAN (Boston Scientific) device in 2015. The Society for Cardiovascular Angiography & Interventions (SCAI) has previously published statements in 2015 and 2016 providing societal overview of the technology and institutional and operator requirements for LAAC. Since then, results from several important clinical trials and registries have been published, technical expertise and clinical practice have matured over time, and the device and imaging technologies have evolved. Therefore, SCAI prioritized the development of an updated consensus statement to provide recommendations on contemporary, evidence-based best practices for transcatheter LAAC focusing on endovascular devices.
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Affiliation(s)
- Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada
| | - David R. Holmes
- Department of Cardiovascular Medicine, Mayo Clinic Health System Rochester, Rochester, Minnesota
| | - João L. Cavalcante
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota
| | - James V. Freeman
- Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - Andrew M. Goldsweig
- Division of Cardiovascular Medicine, The University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Issam D. Moussa
- Carle Heart and Vascular Institute, Carle Illinois College of Medicine, Urbana, Illinois
| | - Thomas M. Munger
- Department of Cardiovascular Medicine, Mayo Clinic Health System Rochester, Rochester, Minnesota
| | - Matthew J. Price
- Division of Cardiovascular Diseases, Scripps Green Hospital, La Jolla, California
| | - Mark Reisman
- Division of Cardiology, Weill Cornell Medical Center, New York, New York
| | | | - Zoltan G. Turi
- Center for Structural and Congenital Heart Disease, Hackensack University Medical Center, Hackensack, New Jersey
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
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12
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Saw J, Holmes DR, Cavalcante JL, Freeman JV, Goldsweig AM, Kavinsky CJ, Moussa ID, Munger TM, Price MJ, Reisman M, Sherwood MW, Turi ZG, Wang DD, Whisenant BK. SCAI/HRS expert consensus statement on transcatheter left atrial appendage closure. Heart Rhythm 2023; 20:e1-e16. [PMID: 36990925 DOI: 10.1016/j.hrthm.2023.01.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Exclusion of the left atrial appendage to reduce thromboembolic risk related to atrial fibrillation was first performed surgically in 1949. Over the past 2 decades, the field of transcatheter endovascular left atrial appendage closure (LAAC) has rapidly expanded, with a myriad of devices approved or in clinical development. The number of LAAC procedures performed in the United States and worldwide has increased exponentially since the Food and Drug Administration approval of the WATCHMAN (Boston Scientific) device in 2015. The Society for Cardiovascular Angiography & Interventions (SCAI) has previously published statements in 2015 and 2016 providing societal overview of the technology and institutional and operator requirements for LAAC. Since then, results from several important clinical trials and registries have been published, technical expertise and clinical practice have matured over time, and the device and imaging technologies have evolved. Therefore, SCAI prioritized the development of an updated consensus statement to provide recommendations on contemporary, evidence-based best practices for transcatheter LAAC focusing on endovascular devices.
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Affiliation(s)
- Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada.
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic Health System Rochester, Rochester, Minnesota
| | - João L Cavalcante
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, The University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Issam D Moussa
- Carle Heart and Vascular Institute, Carle Illinois College of Medicine, Urbana, Illinois
| | - Thomas M Munger
- Department of Cardiovascular Medicine, Mayo Clinic Health System Rochester, Rochester, Minnesota
| | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Green Hospital, La Jolla, California
| | - Mark Reisman
- Division of Cardiology, Weill Cornell Medical Center, New York, New York
| | | | - Zoltan G Turi
- Center for Structural and Congenital Heart Disease, Hackensack University Medical Center, Hackensack, New Jersey
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
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13
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Quintana RA, Dong T, Vajapey R, Reyaldeen R, Kwon DH, Harb S, Wang TKM, Klein AL. Preprocedural Multimodality Imaging in Atrial Fibrillation. Circ Cardiovasc Imaging 2022; 15:e014386. [PMID: 36256725 DOI: 10.1161/circimaging.122.014386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide and is associated with increased risk of heart failure, stroke, and death. In current medical practice, multimodality imaging is routinely used in the management of AF. Twenty-one years ago, the ACUTE trial (Assessment of Cardioversion Using Transesophageal Echocardiography) results were published, and the management of AF changed forever by incorporating transesophageal echocardiography guided cardioversion of patients in AF for the first time. Current applications of multimodality imaging in AF in 2022 include the use of transesophageal echocardiography and computed tomography before cardioversion to exclude left atrial thrombus and in left atrial appendage occlusion device implantation. Transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance are clinically used for AF ablation planning. The decision to use a particular imaging modality in AF is based on patient's characteristics, guideline recommendation, institutional preferences, expertise, and cost. In this first of 2-part review series, we discuss the preprocedural role of echocardiography, computed tomography, and cardiac magnetic resonance in the AF, with regard to their clinical applications, relevant outcomes data and unmet needs, and highlights future directions in this rapidly evolving field.
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Affiliation(s)
- Raymundo A Quintana
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (R.A.Q.)
| | - Tiffany Dong
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Ramya Vajapey
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Reza Reyaldeen
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Deborah H Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Serge Harb
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Tom Kai Ming Wang
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH (T.D., R.V., R.R., D.H.K., S.H., T.K.M.W., A.L.K.)
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14
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Pivato CA, Liccardo G, Sanz‐Sanchez J, Pelloni E, Pujdak K, Xuareb RG, Cruz‐Gonzalez I, Pisano F, Scotti A, Tarantini G, Cook S, Regazzoli D, Reimers B, Condorelli G, Bragato RM, Stefanini GG, Pagnotta P. Left atrial appendage closure with the II generation Ultraseal device: An international registry. The LIGATE study. Catheter Cardiovasc Interv 2022; 100:620-627. [PMID: 35842775 PMCID: PMC9796275 DOI: 10.1002/ccd.30336] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/31/2022] [Accepted: 07/02/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To assess feasibility and safety of second-generation left atrial appendage closure (LAAC) Ultraseal device in patients with nonvalvular atrial fibrillation (NVAF). BACKGROUND LAAC with first-generation Ultraseal device (Cardia, Eagan, Minnesota) has been shown to be a feasible therapeutic option in patients with NVAF. However, there is a paucity of data regarding the novel second-generation Ultraseal device. METHODS All patients with NVAF undergoing second-generation Ultraseal device implantation between February 2018 and September 2020 were included in a multicenter international registry. Periprocedural and post-discharge events were collected through 6-month follow-up. Co-primary efficacy endpoints were device success and technical success while primary safety endpoint was in-hospital major adverse event (MAE) occurrence. RESULTS A total of 52 patients were included: mean age 75 ± 8, 30.8% women, mean HAS-BLED 3 ± 1. The device was successfully implanted in all patients. Technical success was achieved in 50 patients (96.1%). In-hospital MAEs occurred in three patients (5.8%). The incidence of 6-month all-cause death and major bleeding was 11.6% and 2.1%, respectively. No strokes, transient ischemic attacks, systemic embolisms, or device embolization were reported after discharge. CONCLUSIONS Second-generation Ultraseal device implantation was associated with high success rates and a low incidence of peri-procedural complications. Larger studies with longer follow-up are warranted to further evaluate the safety and the efficacy of this device, especially at long-term follow-up.
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Affiliation(s)
- Carlo A. Pivato
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele‐MilanItaly,Cardio CenterIRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Gaetano Liccardo
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele‐MilanItaly,Cardio CenterIRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Jorge Sanz‐Sanchez
- Cardiology DepartmentHospital Universitari i Politècnic La FeValenciaSpain,Centro de Investigación Biomedica en Red (CIBERCV)MadridSpain
| | | | | | | | | | | | - Andrea Scotti
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, del PoliclinicoUniversitario di PadovaPadovaItaly
| | - Giuseppe Tarantini
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, del PoliclinicoUniversitario di PadovaPadovaItaly
| | | | | | - Bernhard Reimers
- Cardio CenterIRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Gianluigi Condorelli
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele‐MilanItaly,Cardio CenterIRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | | | - Giulio G. Stefanini
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele‐MilanItaly,Cardio CenterIRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Paolo Pagnotta
- Cardio CenterIRCCS Humanitas Research HospitalRozzano‐MilanItaly
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15
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Rozen G, Margolis G, Marai I, Roguin A, Rahamim E, Planer D, Heist EK, Amir O, Tahiroglu I, Ruskin J, Mansour M, Elbaz-Greener G. Left atrial appendage exclusion in atrial fibrillation. Front Cardiovasc Med 2022; 9:949732. [PMID: 36176999 PMCID: PMC9513198 DOI: 10.3389/fcvm.2022.949732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Although oral anticoagulants (OACs) are first-line therapy for stroke prevention in patients with atrial fibrillation (AF), some patients cannot be treated with OACs due to absolute or relative contraindications. Left atrial appendage (LAA) exclusion techniques have been developed over the years as a therapeutic alternative for stroke prevention. In this paper, we review the evolution of surgical techniques, employed as an adjunct to cardiac surgery or as a stand-alone procedure, as well as the recently introduced and widely utilized percutaneous LAA occlusion techniques. Until recently, data on surgical LAAO were limited and based on non-randomized studies. We focus on recently published randomized data which strongly support an add-on surgical LAAO in eligible patients during cardiac surgery and could potentially change current practice guidelines. In recent years, the trans-catheter techniques for LAA occlusion have emerged as another, less invasive alternative for patients who cannot tolerate oral anticoagulation. We review the growing body of evidence from prospective studies and registries, focusing on the two systems which are in widespread clinical use nowadays: the Watchman and Amulet type devices. These data show favorable results for both Watchman and Amulet devices, setting them as an important tool in our arsenal for stroke reduction in AF patients, especially in those who have contraindications for OACs. A better understanding of the different therapeutic alternatives, their specific benefits, and downfalls in different patient populations can guide us in tailoring the optimal therapeutic approach for stroke reduction in our AF patients.
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Affiliation(s)
- Guy Rozen
- Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- *Correspondence: Guy Rozen
| | - Gilad Margolis
- Cardiology Division, Hillel Yaffe Medical Center, Hadera, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ibrahim Marai
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Ariel Roguin
- Cardiology Division, Hillel Yaffe Medical Center, Hadera, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Eldad Rahamim
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Edwin Kevin Heist
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ilgar Tahiroglu
- Department of Cardiology, Baku Health Center University, Baku, Azerbaijan
| | - Jeremy Ruskin
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Moussa Mansour
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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16
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Huang PS, Chiu FC, Cheng HL, Hsu JC, Chua SK, Chu CY, Lin TT, Chen JJ, Tsai CT. Peri-device leakage not CHA2DS2-VASc is associated with post-left atrial appendage closure cardiovascular event. J Stroke Cerebrovasc Dis 2022; 31:106688. [PMID: 36095860 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106688] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE In patients with non-valvular atrial fibrillation (NVAF), the left atrial appendage occluder (LAAO) is an alternative treatment for stroke prevention. However, thromboembolic event still occur, and the predictors are unknown. METHODS The first Asian long-term follow-up study consisted of 308 patients with mean age 71.9±9.5 years, mean CHA2DS2-VASc 4.1 ± 1.8 since 2013. Primary outcome was defined as any type of ischemic stroke/transient ischemic attack (TIA), systemic embolization and cardiovascular death. RESULTS There was no procedural-related TIA or stroke. After a mean follow-up of 38±16 months, the ischemic stroke/TIA rate was 1.9 and cardiovascular death rate 0.3 per 100 patient-year. The rate of peri-device leak (PDL) was 11.9% and device-related thrombus (DRT) 2.6%. In the multivariable analyses, PDL was the only independent predictor of stroke/TIA (hazard ratio 5.5, p=0.008). CHA2DS2-VASc score, prior history of stroke, DRT and post-procedural anti-thrombotic regimen/duration were not associated with outcomes. Implantation of Watchman was associated with PDL (odds ratio 4.35, p=0.001). CONCLUSIONS PDL is the only independent predictor of post-LAAO stroke. The risk of stroke for patients with NVAF may be controllable after LAA is occluded, because PDL is preventable and treatable.
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Affiliation(s)
- Pang-Shuo Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Ling Branch, Dou-Liu City, Taiwan
| | - Fu-Chun Chiu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Ling Branch, Dou-Liu City, Taiwan
| | - Hsiao-Liang Cheng
- Department of Anesthesiology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Jung-Cheng Hsu
- Division of Cardiology, Department of Internal Medicine, Far Eastern Memorial hospital, New Taipei City, Taiwan
| | - Su-Kiat Chua
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial, Kaohsiung Taiwan
| | - Ting-Tse Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Jien-Jiun Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Ling Branch, Dou-Liu City, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital; Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
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17
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Zhu MZ, Song H, Song GM, Bai X. Safety and efficacy of the Amplatzer amulet and watchman2.5 for left atrial appendage occlusion: a Systematic review and meta-analysis. Pacing Clin Electrophysiol 2022; 45:1237-1247. [PMID: 35933600 DOI: 10.1111/pace.14576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulation (OAC) to decrease the risk of stroke in patients with nonvalvular atrial fibrillation (NVAF); however, certain complications remain a concern. Amplatzer Amulet and Watchman are the two most popular used devices for preventing stroke in patients with NVAF. We assessed the safety and efficacy of LAAO using the Amplatzer Amulet and Watchman. METHODS A meta-analysis was conducted to compare the safety and efficacy outcomes associated with the use of the Amplatzer Amulet and Watchman 2.5. The Newcastle-Ottawa Scale has been utilized to assess the quality of study. RESULTS The meta-analysis includes seven studies involving 2,926 patients (1,418 patients with an amulet and 1,508 with a Watchman 2.5). Generally, adverse event rates for both systems were minimal. No significant differences between the two devices were found in safety (pericardial effusion, device embolization, and cardiac tamponade) or efficacy outcomes (death, TIA, stroke, major/minor bleeding, device leak, and thromboembolic events). CONCLUSIONS The data suggest LAAO is a safe procedure, regardless of which device was used. LAAO devices generally have low complication rates. Outcomes were comparable between the two groups with no significant differences in their safety or efficacy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ming-Zhen Zhu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Hao Song
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Guang-Min Song
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Xiao Bai
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
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18
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Ciobotaru V, Tadros VX, Martin CA, Hascoet S. Complex transcatheter left atrial appendage closure using a tailored trans-jugular approach simulated by 3D printing: a case report. Eur Heart J Case Rep 2022; 6:ytac304. [PMID: 35965604 PMCID: PMC9366637 DOI: 10.1093/ehjcr/ytac304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 07/20/2022] [Indexed: 11/15/2022]
Abstract
Background Transcatheter left atrial appendage (LAA) closure (LAAc) is less feasible in patients with unusual LAA anatomy. Case summary A 65-year-old woman with persistent atrial fibrillation was referred for LAAc. Transesophageal echocardiography (TEE) revealed spontaneous contrast in the LAA without formation of a thrombus; the LAA shape was tortuous and difficult to assess. A first LAAc procedure was unsuccessful given the unsuitable sheath position. Therefore, a soft three-dimensional (3D) model printing was performed by laser sintering and revealed excessive sheath kinking with an inferior approach, but successful deployment would be feasible using a superior approach. Successful trans-jugular implantation of a Watchman FLX 31 device in stable position without residual leakage was achieved during the subsequent procedure. At 3-month follow-up, and after cessation of oral anticoagulation, the patient’s symptoms improved. Imaging demonstrated complete LAA occlusion and correct placement of the device along the LAA superior axis. Discussion This is the first-reported clinical case of a complex transcatheter LAAc through a trans-jugular approach. Simulating the patient’s anatomy with a laser sintering 3D-printed model showed why the transfemoral approach failed, validated the trans-jugular procedure, enabled selection of the simple curve access sheath that had the most direct trajectory towards the LAA, confirmed that transseptal puncture was possible, allowed determination of the angle of puncture, enabled selection of the most appropriate LAA device and had a very low cost compared with planning software or other printing methods.
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Affiliation(s)
- Vlad Ciobotaru
- Structural and Valvular Unit, Hôpital Privé les Franciscaines , 3 rue Jean Bouin, 30000 Nîmes , France
- Inserm UMR 999, Hôpital Marie Lannelongue, Faculté de Médecine, Université Paris Saclay , 92296 Chatenay-Malabry , France
| | - Victor-Xavier Tadros
- Structural and Valvular Unit, Hôpital Privé les Franciscaines , 3 rue Jean Bouin, 30000 Nîmes , France
| | - Claire A Martin
- Division of Cardiac Electrophysiology, Royal Papworth Hospital NHS Foundation Trust , Cambridge CB2 0AY , UK
| | - Sebastien Hascoet
- Inserm UMR 999, Hôpital Marie Lannelongue, Faculté de Médecine, Université Paris Saclay , 92296 Chatenay-Malabry , France
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph , 92350 Le Plessis-Robinson , France
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19
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Single versus Dual Antiplatelet Therapy following Left Atrial Appendage Occlusion in Patients with High Bleeding Risk. Curr Probl Cardiol 2022; 47:101269. [DOI: 10.1016/j.cpcardiol.2022.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
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20
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Korsholm K, Damgaard D, Valentin JB, Packer EJS, Odenstedt J, Sinisalo J, Putaala J, Næss H, Al-Jazi MA, Karlsson JE, Pontoppidan J, Modrau B, Hjort J, Matzen KL, Johnsen SP, Nielsen-Kudsk JE. Left atrial appendage occlusion vs novel oral anticoagulation for stroke prevention in atrial fibrillation: rationale and design of the multicenter randomized occlusion-AF trial. Am Heart J 2022; 243:28-38. [PMID: 34537184 DOI: 10.1016/j.ahj.2021.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prevalence of atrial fibrillation (AF) is increasing globally, which is a major clinical and public health concern due to the 5-fold increased risk of stroke. Oral anticoagulation with novel oral anticoagulants (NOACs) is the current primary option for stroke prevention in patients with AF, although it increases the risk of major bleeding. Patients with prior ischemic cerebrovascular events are at particularly high risk of both recurrent ischemic events and major bleeding. Left atrial appendage occlusion (LAAO) provides an alternative option for stroke prevention in high-risk patients, however, with currently limited evidence. Thus, randomized trials comparing LAAO to NOACs are needed. OBJECTIVE The Occlusion-AF trial is designed to assess whether LAAO is non-inferior to NOAC therapy for reduction of the combined endpoint of stroke, systemic embolism, major bleeding (Bleeding Academic Research Consortium ≥ 3) and all-cause mortality in patients with AF and a recent ischemic stroke or transient ischemic attack (TIA). METHODS AND ANALYSIS Investigator-initiated multicenter, multinational, randomized open-label non-inferiority trial with blinded outcome evaluation (PROBE design). Patients with documented AF, and an ischemic stroke or TIA within 6 months will be eligible for enrollment. Major exclusion criteria are modified Rankin Scale > 3 at enrollment, glomerular filtration rate < 15 ml/min, and life-expectancy less than 2 years. A total of 750 patients will be randomized 1:1 to receive either a NOAC or LAAO using the Amplatzer Amulet (Abbott, MN, USA) or Watchman FLX (Boston Scientific, MN, USA) with subsequent life-long aspirin 75 mg daily. Follow-up will be based on in-office and telephone follow-up in combination with long-term follow-up (10 years) through national hospital discharge registries in the individual Nordic countries. The primary outcome will be a composite endpoint of stroke, systemic embolism, major bleeding (BARC ≥ 3) and all-cause mortality at 2-year follow-up. CONCLUSIONS The Occlusion-AF trial is designed to compare LAAO to NOAC therapy for secondary stroke prevention in AF patients with a high risk of recurrent thromboembolic events, i.e. with previous ischemic stroke or TIA, and otherwise eligible for anticoagulation. The results are expected to contribute significantly to the understanding of the effects of LAAO compared to the standard contemporary pharmacological treatment in these patients.
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Affiliation(s)
- Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark; Department of Cardiology, Regional Hospital, West Jutland, Denmark
| | - Dorte Damgaard
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | | | - Jacob Odenstedt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Central Hospital, and Helsinki University Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Finland
| | - Halvor Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Jan-Erik Karlsson
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacob Pontoppidan
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Boris Modrau
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Jakob Hjort
- Clinical Trial Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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21
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Agudelo V, Millán X, Li CH, Moustafa AH, Asmarats L, Serra A, Arzamendi D. Prevalence, mechanisms and impact of residual patency and device-related thrombosis following left atrial appendage occlusion: a computed tomography analysis. EUROINTERVENTION 2021; 17:e944-e952. [PMID: 34219668 PMCID: PMC9724939 DOI: 10.4244/eij-d-21-00320] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cardiac computed tomography angiography (CCTA) appears to be an appropriate imaging technique for device surveillance after left atrial appendage occlusion (LAAO). However, the available experience is limited. AIMS The aim of this study was to determine the prevalence, mechanisms and clinical impact of left atrial appendage (LAA) patency and device-related thrombosis (DRT) following LAAO utilising a novel CCTA-based classification. METHODS Consecutively enrolled patients who underwent LAAO with an AMPLATZER device were followed up with CCTA. Mechanisms and frequency of residual patency were evaluated and correlated with clinical events. Atrial-side device thrombus, device positioning and presence of signs of device stability were also analysed. RESULTS A total of 137 patients were included. LAA patency was observed in 56.9% (n=78). Mechanisms and frequency of patency were: malapposition of proximal segment of the device lobe (55.1%), peri-device leak (PDL, 34.6%) and fabric permeability (5.8%). Lobe-LAA axis misalignment was the only independent predictor of device patency after LAAO (HR 38.3, 95% CI: 13.6-107.0; p<0.001). After a median follow-up of 638 days, patency was not associated with an increased risk of death (all-cause or cardiovascular death) or cerebral/peripheral embolism regardless of its mechanism. Any degree of hypo-attenuated thickening (HAT) was found in 16.8% (n=23) of patients, of whom 16 (11.7%) had low-grade HAT and 7 (5.1%) had high-grade HAT or definite DRT. Complete sealing was associated with increased rates of low-grade HAT. CONCLUSIONS LAA patency on CCTA follow-up is a frequent phenomenon due to malapposition of the proximal segment of the device lobe, PDL or fabric permeability. Patency was not associated with adverse outcomes. Low-grade HAT may be related to a benign, uneventful, endothelialisation process favoured by complete LAAO.
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Affiliation(s)
- Victor Agudelo
- Interventional Cardiology Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Millán
- Interventional Cardiology Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Chi-Hion Li
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Abdel-Hakim Moustafa
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluis Asmarats
- Interventional Cardiology Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Serra
- Interventional Cardiology Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dabit Arzamendi
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau, Sant Antoni M. Claret 167, 08025 Barcelona, Spain
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22
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Chiu FC, Huang PS, Chen JJ, Hwang JJ, Tsai CT. Long-term outcomes of percutaneous left atrial appendage closure for the prevention of stroke in patients with atrial fibrillation: Asia-Pacific experience. J Formos Med Assoc 2021; 121:1442-1449. [PMID: 34799213 DOI: 10.1016/j.jfma.2021.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 09/30/2021] [Accepted: 10/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND/PURPOSE In patients with non-valvular atrial fibrillation (NVAF), the left atrial appendage occluder (LAAO) is an alternative treatment for stroke prevention. However, the long-term outcomes in Asia was generally unknown. METHODS AND RESULTS This was a retrospective longitudinal study and a total of 124 patients with contraindications to oral anticoagulants or stroke despite under anticoagulants had been enrolled since 2013. Primary efficacy was defined as any type of stroke/systemic embolization and adverse event as any procedure or anti-thrombotic related complications. Twelve patients were excluded due to thrombus in the LAA or oversize LAA. Watchman was successfully implanted in 55 patients (98%) and ACP/Amulet also 55 patients (98%). During follow-up, the ischemic stroke rate was 1.9 in the Watchman and 1.4 per 100 patient-year in the ACP/Amulet group. There were 2 Watchman patients experiencing intracranial hemorrhage. Device-related thrombus (DRT) was noted in 3 patients (2.7%).There was no patient with peri-device lead ≧5 mm. In those patients receiving only local anesthesia, the follow-up echocardiography showed no significant peri-device leak, malposition of LAAO and DRT. CONCLUSION This long-term follow-up study shows that percutaneous closure of LAA is a safe and technically feasible procedure with satisfactory outcomes in Asia. The procedure success rate, efficacy and adverse event were similar to those reported in the Caucasian populations.
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Affiliation(s)
- Fu-Chun Chiu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Pang-Shuo Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Jien-Jiun Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
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23
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Saad M, Osman M, Hasan-Ali H, Abdel Ghany M, A Alsherif M, Risha O, Sano M, Fink T, Heeger CH, Vogler J, Sciacca V, Eitel C, Stiermaier T, Joost A, Keelani A, Fuernau G, Saraei R, Kuck KH, Eitel I, Tilz RR. Atrial appendage closure in patients with heart failure and atrial fibrillation: industry-independent single-centre study. ESC Heart Fail 2021; 9:648-655. [PMID: 34783164 PMCID: PMC8788055 DOI: 10.1002/ehf2.13698] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/10/2021] [Accepted: 10/29/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS To evaluate outcomes of percutaneous left atrial appendage closure (LAAC) in patients with congestive heart failure (CHF) and non-valvular atrial fibrillation (AF) in a consecutive, industry-independent registry associated with periprocedural success and complications during long-term follow-up. METHODS AND RESULTS For this analysis, we included patients who underwent transcatheter LAAC from January 2014 to December 2019 at the University Heart Center in Lübeck, Germany, and compared patients with presence of CHF defined as patients with a reduced left ventricular ejection fraction (LVEF ≤ 40%), patients with a mid-range LVEF (LVEF 41-49%), patients with diastolic dysfunction and preserved LVEF (LVEF ≥ 50%), and patients with right-sided heart failure and impaired right ventricular function (tricuspid annular plane systolic excursion < 17) to patients undergoing LAAC with no CHF. Primary endpoints were defined as periprocedural complications, and complications during long-term follow-up presented as major adverse cardiac and cerebrovascular events (MACCE). A total of 300 consecutive patients underwent LAAC. Of these, 96 patients in the CHF group were compared with 204 patients in the non-CHF group. Implantation success was lower in CHF group in comparison with non-CHF group (99.5% vs. 96%, P = 0.038); otherwise, there were no differences in periprocedural complications between groups. Patients with CHF showed a significantly higher incidence of MACCE rate (31.9% vs. 15.1%, P = 0.002) and more deaths (24.2% vs. 7%, P ≤ 0.001) during long-term follow-up. In Cox multivariable regression analysis, CHF was an independent predictor of mortality after LAAC implantation at long-term follow-up (hazard ratio 3.23, 95% confidence intervals 1.52-6.86, P = 0.002). CONCLUSIONS Implantation of LAAC devices in patients with non-valvular AF and CHF is safe. The increased mortality in patients with CHF compared with patients without CHF during the long-term follow-up is mainly attributed to comorbidities associated with CHF.
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Affiliation(s)
- Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Arnold-Heller-Str.3, Haus K3, Kiel, 24105, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Mohamed Osman
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,Department of Cardiology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Hosam Hasan-Ali
- Department of Cardiology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | | | - Mohamad A Alsherif
- Department of Cardiology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Osama Risha
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Makoto Sano
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, Division of Electrophysiology, University Heart Center Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany
| | - Thomas Fink
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, Division of Electrophysiology, University Heart Center Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany
| | - Christian-Hendrik Heeger
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, Division of Electrophysiology, University Heart Center Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany
| | - Julia Vogler
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, Division of Electrophysiology, University Heart Center Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany
| | - Vanessa Sciacca
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, Division of Electrophysiology, University Heart Center Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany
| | - Charlotte Eitel
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, Division of Electrophysiology, University Heart Center Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany
| | - Thomas Stiermaier
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Alexander Joost
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Ahmad Keelani
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, Division of Electrophysiology, University Heart Center Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany
| | - Georg Fuernau
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Roza Saraei
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Karl-Heinz Kuck
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, Division of Electrophysiology, University Heart Center Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany
| | - Ingo Eitel
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Roland Richard Tilz
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.,Medical Clinic II, Division of Electrophysiology, University Heart Center Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany
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24
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Schmidt B, Chun KRJ. Preliminary or Premature?: The Dilemma of Early Data Reporting Leaving Questions Unanswered. JACC Cardiovasc Interv 2021; 14:2375-2376. [PMID: 34736736 DOI: 10.1016/j.jcin.2021.08.064] [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: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Frankfurt, Germany.
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Frankfurt, Germany
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25
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Afzal S, Piayda K, Hellhammer K, Veulemans V, Wolff G, Heidari H, Stüwe D, Kanschik D, Polzin A, Kelm M, Zeus T. Real-time echocardiography-fluoroscopy fusion imaging for left atrial appendage closure: prime time for fusion imaging? Acta Cardiol 2021; 76:1004-1012. [PMID: 33435834 DOI: 10.1080/00015385.2020.1870193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Real-time echocardiography-fluoroscopy fusion imaging (FI) merges real-time echocardiographic imaging with fluoroscopic images allowing intuitive anatomical spatial orientation during structural heart disease interventions. We aimed to assess the safety and efficacy of FI during percutaneous left atrial appendage closure (LAAC). METHODS 34 consecutive patients before (-FI) and 121 patients after (+FI) the introduction of FI for LAAC were included in a single-centre study. In-hospital safety parameters were analysed according to adverse event (AE) definition of the Munich consensus document and procedure-related parameters were assessed for efficacy. An ANCOVA was performed to investigate the influence of a learning curve. RESULTS Time until successful transseptal puncture was significantly reduced as well as total procedure time and the amount of contrast agent used (+FI/-FI:17 ± 6.35 min vs. 22 ± 8.33 min, p = 0.001; +FI/-FI: 50 min IQR 43 min - 60 min vs. 57 min IQR 45 min -70 min; p = 0.013; +FI/-FI: 70 mL, IQR 55 ml-90 mL vs. 152 mL, IQR 107 mL - 205 mL; p < 0.001). However, fluoroscopy time and dose-area product did not differ between both groups. There was no significant difference in the occurrence of in-hospital adverse events (+FI/-FI: 2.5% vs. 0%; p = 0.596). The ANCOVA revealed that the learning curve does not affect procedural efficacy parameters such as procedure time, time to transseptal puncture, amount of contrast agent and dose-area product. CONCLUSIONS FI for LAAC reduces the total procedure time, the time to successful transseptal puncture and periprocedural amount of contrast agent.
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Affiliation(s)
- Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Kerstin Piayda
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Katharina Hellhammer
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Houtan Heidari
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Dominique Stüwe
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Dominika Kanschik
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, University Medical Center Düsseldorf, Düsseldorf, Germany
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26
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Saad M, Risha O, Sano M, Fink T, Heeger CH, Vogler J, Sciacca V, Eitel C, Stiermaier T, Joost A, Keelani A, Fuernau G, Meyer-Saraei R, Kuck KH, Eitel I, Richard Tilz R. Comparison between Amulet and Watchman left atrial appendage closure devices: A real-world, single center experience. IJC HEART & VASCULATURE 2021; 37:100893. [PMID: 34712772 PMCID: PMC8529070 DOI: 10.1016/j.ijcha.2021.100893] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 11/20/2022]
Abstract
Background Data reporting a head-to-head comparison between Amulet and Watchman devices are scarce. The aim of this study was to compare the Watchman™ versus Amulet™ left atrial appendage closure (LAAC) devices in a consecutive, industry-independent registry. Methods Patients who underwent LAAC using Watchman or Amulet devices from January 2014 to December 2019 at the University Heart Center Lübeck, Lübeck, Germany were included in the present analysis. Primary endpoints included periprocedural complications (in-hospital death, pericardial tamponade, device embolization, stroke, major bleeding and vascular access complications), and complications during long-term follow-up (ischemic stroke, hemorrhagic stroke, thromboembolism, device thrombus, bleeding and death). Results After matching the patients for age (±5 years), gender, CHA2DS2Vasc score (±1) and HASBLED score (±1), each of the Watchman and the Amulet groups included 113 patients. Patients in the Amulet group had significantly more periprocedural complications (2.7% vs 10.6%, p = 0.029; respectively) and more major bleeding complications (0% vs 5.3%, p = 0.029; respectively). During long-term follow-up, the rate of events was comparable between the Watchman and Amulet groups (18.3% versus 20.8%, p = 0.729; respectively). Conclusion Amulet LAAC device was associated with increased periprocedural complications as compared to Watchman LAAC device. On long-term follow-up, both devices showed comparable efficacy and safety.
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Affiliation(s)
- Mohammed Saad
- Medical Clinic III, University Hospital Schleswig-Holstein, Kiel, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Osama Risha
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Makoto Sano
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Fink
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christian-Hendrik Heeger
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Julia Vogler
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Vanessa Sciacca
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Charlotte Eitel
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Alexander Joost
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ahmad Keelani
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Georg Fuernau
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Roza Meyer-Saraei
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Karl-Heinz Kuck
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Roland Richard Tilz
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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27
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Calabrò P, Gragnano F, Niccoli G, Marcucci R, Zimarino M, Spaccarotella C, Renda G, Patti G, Andò G, Moscarella E, Mancone M, Cesaro A, Giustino G, De Caterina R, Mehran R, Capodanno D, Valgimigli M, Windecker S, Dangas GD, Indolfi C, Angiolillo DJ. Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease. Circulation 2021; 144:1323-1343. [PMID: 34662163 DOI: 10.1161/circulationaha.121.054305] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Contemporary evidence supports device-based transcatheter interventions for the management of patients with structural heart disease. These procedures, which include aortic valve implantation, mitral or tricuspid valve repair/implantation, left atrial appendage occlusion, and patent foramen ovale closure, profoundly differ with respect to clinical indications and procedural aspects. Yet, patients undergoing transcatheter cardiac interventions require antithrombotic therapy before, during, or after the procedure to prevent thromboembolic events. However, these therapies are associated with an increased risk of bleeding complications. To date, challenges and controversies exist regarding balancing the risk of thrombotic and bleeding complications in these patients such that the optimal antithrombotic regimens to adopt in each specific procedure is still unclear. In this review, we summarize current evidence on antithrombotic therapies for device-based transcatheter interventions targeting structural heart disease and emphasize the importance of a tailored approach in these patients.
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Affiliation(s)
- Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).,Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano," Caserta, Italy (P.C., F.G., E.M., A.C.)
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).,Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano," Caserta, Italy (P.C., F.G., E.M., A.C.)
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (G.N.).,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy (G.N.).,Department of Medicine, University of Parma, Italy (G.N.)
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Italy (R. Marcucci.)
| | - Marco Zimarino
- Institute of Cardiology, University "G. D'Annuzio" of Chieti-Pescara, Italy (M.Z., G.R)
| | - Carmen Spaccarotella
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy (C.S., C.I.)
| | - Giulia Renda
- Institute of Cardiology, University "G. D'Annuzio" of Chieti-Pescara, Italy (M.Z., G.R)
| | - Giuseppe Patti
- Department of Translational Medicine, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Via Solaroli, Novara, Italy (G.P.)
| | - Giuseppe Andò
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (G.A.)
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).,Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano," Caserta, Italy (P.C., F.G., E.M., A.C.)
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy (M.M.)
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).,Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano," Caserta, Italy (P.C., F.G., E.M., A.C.)
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.G., R. Mehran., G.D.D.)
| | - Raffaele De Caterina
- University Cardiology Division, University of Pisa, Pisa University Hospital, Italy; Fondazione Villa Serena per la Ricerca, Città Sant'Angelo, Italy (R.D.C.)
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.G., R. Mehran., G.D.D.)
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti, Catania, Italy (D.C.).,Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Italy (D.C.)
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (M.V.).,Department of Cardiology, Bern University Hospital, University of Bern, Switzerland (M.V., S.W.)
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland (M.V., S.W.)
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.G., R. Mehran., G.D.D.)
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy (C.S., C.I.).,Mediterranea Cardiocentro, Naples, Italy (C.I.)
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.)
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28
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[Left atrial appendage closure : Current data and future developments]. Herz 2021; 46:452-466. [PMID: 34463787 DOI: 10.1007/s00059-021-05065-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Catheter-based left atrial appendage closure (LAAC) is currently a potential treatment option for stroke prevention in patients with atrial fibrillation and high risk for stroke/embolism as well as high bleeding risk. Due to improvements in LAAC devices, advances in implantation techniques and growing experience of the interventional teams, the safety profile of LAAC has significantly improved in recent years. These developments have led to a currently comprehensive exploration of novel indications for LAAC, such as patients with atrial fibrillation and a low risk of hemorrhage, patients with atrial fibrillation after pulmonary vein ablation or patients after electrical isolation of the left atrial appendage. The treatment principle of closure of the left atrial appendage is supported by new data, which show the effectiveness of surgical closure of the left atrial appendage with respect to a reduction of the risk of stroke, at least partly in conjunction with oral anticoagulation during cardiological surgical interventions. Currently, the application in the clinical practice is reflected by a high degree of active studies. These randomized studies are testing the use of LAAC in new fields of application and together with the new developments in implantation techniques should define the optimal future use of the methods for the clinical practice. The current potential indications for the LAAC procedure, ongoing randomized clinical trials and advances in device development, implantation planning and technique as well as future developments in the field of LAAC treatment are summarized and discussed in this review article.
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29
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Impact of HAS-BLED Score on outcome after percutaneous left atrial appendage closure: insights from the German Left Atrial Appendage Occluder Registry LAARGE. Clin Res Cardiol 2021; 111:541-547. [PMID: 34455462 DOI: 10.1007/s00392-021-01911-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
AIM Percutaneous left atrial appendage (LAA) closure has been established as alternative stroke prophylaxis in patients with non-valvular atrial fibrillation (AF) and high bleeding risk. However, little is known regarding the outcome after LAA closure depending on the HAS-BLED score. METHODS A sub-analysis of the prospective, multicenter, Left-Atrium-Appendage Occluder Register-GErmany (LAARGE) registry was performed assessing three different groups with respect to the HAS-BLED score (0-2 [group 1] vs. 3-4 [group 2] vs. 5-7 [group 3]). RESULTS A total of 633 patients at 38 centers were enrolled. Of them, 9% (n = 59) were in group 1, 63% (n = 400) in group 2 and 28% (n = 174) in group 3. The Kaplan-Meier estimated 1-year composite of death, stroke and systemic embolism was 3.4% in group 1 vs. 10.4% in group 2 vs. 20.1% in group 3, respectively (p log-rank < 0.001). The difference was driven by death since stroke and systemic embolism did not show a significant difference between the groups. The rate of major bleeding at 1 year was 0% vs. 0% vs. 2.4%, respectively (p = 0.016). CONCLUSION The present data show that patients had similarly low rates of ischemic complications 1 year after LAA closure irrespective of the baseline bleeding risk. Higher HAS-BLED scores were associated with increased mortality due to higher age and more severe comorbidity of these patients.
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Piayda K, Afzal S, Nielsen-Kudsk JE, Schmidt B, Mazzone P, Berti S, Fischer S, Lund J, Montorfano M, Hildick-Smith D, Gage R, Zhao H, Zeus T. Length of stay following percutaneous left atrial appendage occlusion: Data from the prospective, multicenter Amplatzer Amulet Occluder Observational Study. PLoS One 2021; 16:e0255721. [PMID: 34375347 PMCID: PMC8354446 DOI: 10.1371/journal.pone.0255721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/30/2021] [Indexed: 01/25/2023] Open
Abstract
Aims To evaluate factors influencing the length of stay in patients undergoing percutaneous left atrial appendage occlusion (LAAO). Methods and results Patient characteristics, procedural data and the occurrence of serious adverse events were analyzed from the AmplatzerTM AmuletTM Occluder Observational Study. Patients were divided into three groups: same day (S, 0day, n = 60, 5.6%) early (E, 1day, n = 526, 48.9%), regular (R, 2-3days, n = 338, 31.4%) and late (L, ≥4days, n = 152, 14.1%) discharge and followed up for 60 days. Procedure and device related SAE during the in-hospital stay (S: 0.0% vs. E: 1.0% vs. R: 2.1% vs. L: 23%, p<0.0001) were a major trigger for a prolonged in-hospital stay. Of the 37 subjects in the late discharge group with an SAE prior to discharge, cardiac or bleeding complications were the most common underlying conditions, occurring in 26 subjects. Multinomial logistic analysis only identified HAS-BLED score as an independent influencing factor (p = 0.04) for a late discharge. After 60 days, mortality tended to be greatest in the late discharge group (S: 0.0% vs. E: 1.0% vs. R: 1.2% vs. L: 3.3%, p = 0.1066). Conclusion Over half of the subjects receiving an Amplatzer Amulet occluder were discharged within 1 day of the implant procedure. Serious adverse events were a major trigger for a late discharge after LAAO. Increased HAS-BLED score was associated with a prolonged in-hospital stay.
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Affiliation(s)
- Kerstin Piayda
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Shazia Afzal
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Medizinische Klinik 3 –Kardiologie, Frankfurt, Germany
| | - Patrizio Mazzone
- Arrhythmology and Cardiac Pacing Unit, Ospedale San Raffaele, Milan, Italy
| | - Sergio Berti
- Department of Interventional and Diagnostic Cardiology, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Sven Fischer
- Department of Cardiology, Harzklinikum Dorothea Christiane Erxleben GmbH, Quedlinburg, Germany
| | - Juha Lund
- Heart Center, Turku University Hospital, Turku, Finland
| | | | - David Hildick-Smith
- Sussex Cardiac Center, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Ryan Gage
- Structural Heart, Abbott, St. Paul, Minnesota, United States of America
| | - Hong Zhao
- Structural Heart, Abbott, St. Paul, Minnesota, United States of America
| | - Tobias Zeus
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- * E-mail:
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Korsholm K, Jensen JM, Nørgaard BL, Samaras A, Saw J, Berti S, Tzikas A, Nielsen-Kudsk JE. Peridevice Leak Following Amplatzer Left Atrial Appendage Occlusion: Cardiac Computed Tomography Classification and Clinical Outcomes. JACC Cardiovasc Interv 2021; 14:83-93. [PMID: 33413869 DOI: 10.1016/j.jcin.2020.10.034] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aimed to investigate cardiac computed tomography (CT) and transesophageal echocardiography (TEE) peridevice leak (PDL) assessments, and the clinical relevance of PDL. BACKGROUND PDL assessment is integral during follow-up after left atrial appendage (LAA) occlusion. Comparative studies of TEE and cardiac CT are sparse, and the clinical relevance of PDL is uncertain. METHODS This was a single-center observational study of consecutive patients undergoing LAA occlusion with Amplatzer devices (Amplatzer Cardiac Plug/Amulet) between 2010 and 2018 (N = 415). Patients with both 8-week CT and TEE were included for analysis (n = 346). Images were analyzed by blinded investigators (K.K. and A.S.). PDL on cardiac CT was classified from grade 1 to 3, based on PDL at the device disc, device lobe, and LAA contrast patency. Primary clinical outcome was a composite of ischemic stroke, transient ischemic attack, systemic embolism, or all-cause death. RESULTS PDL was present in 110 patients (32%) by TEE, with 29 (8%) >3 mm. By cardiac CT, 210 patients (61%) had PDL at the disc, with contrast patency in 204 patients (59%). A grade 3 PDL (gap at disc, lobe, and LAA contrast patency) was present in 63 patients (18%). Bland-Altman analysis showed poor agreement between CT and TEE for leak sizing. CT and TEE detected PDL was not significantly associated with worse outcome, hazard ratio: 1.82 (95 % confidence interval: 0.95 to 3.50); p = 0.07 and hazard ratio: 1.43 (95% confidence interval: 0.74 to 2.76); p = 0.28, respectively. CONCLUSIONS PDL occurrence is substantially higher with CT compared with TEE, with a large discrepancy between modalities in leak quantification. A novel CT-based classification is proposed, yet PDL was not associated with worse clinical outcome.
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Affiliation(s)
- Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Regional Hospital West Jutland, Herning, Jutland, Denmark.
| | | | | | | | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Sergio Berti
- Department of Cardiology, Fondazione CNR Regione Toscana, Massa, Italy
| | - Apostolos Tzikas
- AHEPA General Hospital of Aristotle University, Thessaloniki, Greece
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Kleinecke C, Lewalter T, Sievert H, Geist V, Zeymer U, Mudra H, Pleger S, Hochadel M, Senges J, Brachmann J. Interventional occlusion of left atrial appendage in patients with atrial fibrillation. Gender-related outcomes in the German LAARGE Registry. J Cardiovasc Electrophysiol 2021; 32:2636-2644. [PMID: 34314065 DOI: 10.1111/jce.15189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/01/2021] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Gender-based differences in atrial fibrillation have been identified, but limited data exist for patients undergoing left atrial appendage occluder (LAAO) implantation. This study reports gender-related periprocedural and 1-year outcomes of the prospective, multicenter German left atrial appendage occlusion registry (LAARGE). METHODS LAARGE enrolled 641 patients who were scheduled for LAAO implantation from July 2014 to January 2016 in 38 hospitals in Germany. The data collected included demographics, clinical characteristics, details of implantation, and outcome. Efficacy and safety at 1-year follow-up were assessed by the occurrence of thrombembolic and bleeding events, as well as mortality. RESULTS Of 638 patients undergoing LAAO implantation 38.9% were female and 61.1% male. Females were older (76.4 ± 8.2 [females] vs. 75.6 ± 7.7 [males], p = .042) and had a higher stroke risk (CHA2 DS2 -VASc score: 4.9 ± 1.5 vs. 4.3 ± 1.5, p < .001). In contrast, males suffered more often from coronary artery (33.1% vs. 53.8%, p < .001) and vascular disease (18.5% vs. 31.0%, p < .001). Technical success was high and similar for both genders (98.4% vs. 97.2%, p = .33). Severe periprocedural complications (6.9% vs. 3.1%, p = .032) occurred more often in females. At 1-year follow-up the rates of all-cause stroke (0.5% vs. 1.3%, p = .65) and severe bleeding (0.0% and 1.0%, p = .29) were low and comparable between the genders. Also, one-year all-cause mortality (9.2% vs. 13.1%, p = .14) did not differ significantly. CONCLUSION LAARGE documented in this elderly patient population undergoing LAAO implantation a higher rate of severe periprocedural complications in females. At 1-year follow-up similar efficacy and safety outcomes were observed for both genders.
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Affiliation(s)
- Caroline Kleinecke
- Department of Cardiology, Klinikum Hochrhein, Waldshut-Tiengen, Germany
- Department of Cardiology, Klinikum Coburg, Coburg, Germany
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Peter Osypka Heart Center Munich, Munich, Germany
| | | | - Volker Geist
- Department of Cardiology, Klinikum Bad Segeberg, Bad Segeberg, Germany
| | - Uwe Zeymer
- Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany
- Institut für Herzinfarktforschung, Ludwigsburg, Germany
| | - Harald Mudra
- Department of Cardiology, Klinikum Neuperlach, Munich, Germany
| | - Sven Pleger
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jochen Senges
- Institut für Herzinfarktforschung, Ludwigsburg, Germany
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Nielsen-Kudsk JE, Korsholm K, Damgaard D, Valentin JB, Diener HC, Camm AJ, Johnsen SP. Clinical Outcomes Associated With Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulation in Atrial Fibrillation. JACC Cardiovasc Interv 2021; 14:69-78. [PMID: 33413867 DOI: 10.1016/j.jcin.2020.09.051] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/14/2020] [Accepted: 09/29/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study sought to investigate clinical outcomes associated with left atrial appendage occlusion (LAAO) versus direct oral anticoagulants (DOACs) in patients with high-risk atrial fibrillation (AF). BACKGROUND LAAO has been shown to be noninferior to warfarin for stroke prevention in AF. However, anticoagulation with DOACs is now preferred over warfarin as thromboprophylaxis in AF. METHODS Patients with AF enrolled in the Amulet Observational Registry (n = 1,088) who had successful LAAO with the Amplatzer Amulet device (n = 1,078) were compared with a propensity score-matched control cohort of incident AF patients (n = 1,184) treated by DOACs identified from Danish national patient registries. Propensity score matching was based on the covariates of the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category) and HAS-BLED (hypertension, abnormal renal or liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol) scores for predicting stroke and bleeding. The primary outcome was a composite of ischemic stroke, major bleeding (Bleeding Academic Research Consortium ≥3), or all-cause mortality, and follow-up was 2 years. RESULTS AF patients treated with LAAO had a significantly lower risk of the primary composite outcome as compared with patients treated with DOACs (hazard ratio [HR]: 0.57; 95% confidence interval [CI]: 0.49 to 0.67). Total events and event rates per 100 patient-years were (LAAO vs. DOACs) 256 vs. 461 and 14.5 vs. 25.7, respectively. The risk of ischemic stroke was comparable between groups (HR: 1.11; 95% CI: 0.71 to 1.75), while risk of major bleeding (HR: 0.62; 95% CI: 0.49 to 0.79) and all-cause mortality (HR: 0.53; 95% CI: 0.43 to 0.64) were significantly lower in patients treated with LAAO. CONCLUSIONS Among high-risk AF patients, LAAO in comparison with DOACs may have similar stroke prevention efficacy but lower risk of major bleeding and mortality.
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Affiliation(s)
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Dorte Damgaard
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty of the University Duisburg-Essen, Essen, Germany
| | - Alan John Camm
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St. Georgés University of London, London, United Kingdom
| | - Soren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Clinical Impact of Preprocedural CT-Based 3D Computational Simulation of Left Atrial Appendage Occlusion with Amulet. J Interv Cardiol 2021; 2021:9972228. [PMID: 34385893 PMCID: PMC8328713 DOI: 10.1155/2021/9972228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/21/2021] [Accepted: 05/05/2021] [Indexed: 11/18/2022] Open
Abstract
Aims Standard of care (SoC) device size selection with transoesophageal echocardiography (TOE) and computed tomography (CT) in LAAO can be challenging due to a certain degree of variability at both patient and device levels. The aim of this study was to prospectively evaluate the clinical impact of 3D computational modelling software in the decision-making of left atrial appendage occlusion (LAAO) with Amplatzer Amulet. Methods and Results SoC preprocedural assessments as well as CT-based 3D computational simulations (FEops) were performed in 15 consecutive patients scheduled for LAAO with Amulet. Preprocedural device size selection and degree of confidence were determined after SoC and after FEops-based assessments and compared to the implanted device. FEops-based preprocedural assessment correctly selected the implanted device size in 11 out of 15 patients (73.3%), compared to 7 patients (46.7%) for SoC-based assessment. In 4 patients (26.7%), FEops induced a change in device size initially selected by SoC. In the 7 patients (46.7%) in which FEops confirmed the SoC device size selection, the degree of confidence of the size selection increased from 6.4 ± 1.4 for SoC to 8.1 ± 0.7 for FEops. One patient (6.7%) could not be implanted for anatomical reason, as correctly identified by FEops. Conclusions Preprocedural 3D computational simulation by FEops impacts Amulet size selection in LAAO compared to TOE and CT-based SoC assessment. Operators could consider FEops computational simulation in their preprocedural device size selection.
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Schmidt B, Bordignon S, Chen S, Chun KRJ. What Does the Future Hold?: Ideal Device, Newer Devices, and More. Card Electrophysiol Clin 2021; 12:125-130. [PMID: 32067642 DOI: 10.1016/j.ccep.2019.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Please verify if "pigtail guided" should be "pigtail catheter-guided": Recent design changes for left atrial appendage (LAA) closure devices have led to significant improvement by facilitating the procedural workflow (no need for pigtail guided LAA intubation), moving the workspace from distal LAA to the landing zone (closed distal end design), and improving device stability (different anchor design). The availability of different device types (plug vs disc-lobe design) offers an option to tailor a device type to a patient's anatomy; thereby, sealing results have improved substantially. The issue of device-related thrombus has not been resolved and deserves future research, with the goal of eliminating postprocedural antithrombotic medication without increasing risk for stroke.
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Affiliation(s)
- Boris Schmidt
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Wilhelm-Epstein Strasse 4, Frankfurt/Main 60431, Germany.
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Wilhelm-Epstein Strasse 4, Frankfurt/Main 60431, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Wilhelm-Epstein Strasse 4, Frankfurt/Main 60431, Germany
| | - Kyoung Ryul Julian Chun
- Cardioangiologisches Centrum Bethanien, AGAPLESION Markus Krankenhaus, Wilhelm-Epstein Strasse 4, Frankfurt/Main 60431, Germany
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Tacher V, Sifaoui I, Kharrat R, Dacher JN, Chevance V, Gallet R, Teiger E, Kobeiter H, Le Pennec V, Jacquier A, Mandry D, Macron L, Derbel H, Deux JF. The use of cardiac computed tomography angiography in the assessment of percutaneous left atrial appendage closure - Review and experts recommendations endorsed by the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle. Diagn Interv Imaging 2021; 102:586-592. [PMID: 34147390 DOI: 10.1016/j.diii.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Atrial fibrillation is the most common cause of arrhythmia which is responsible for over 15% of ischemic strokes, most of these being secondary to migration of a left atrial appendage (LAA) thrombus. In patient with contraindication to anticoagulant therapy, percutaneous closure system placement may be indicated. Cardiac computed tomography (CT) angiography plays a central role in the initial assessment as well as in the follow-up. The purpose of the pre-implantation cardiac CT angiography is to evaluate the anatomy of the LAA in order to select the most suitable prosthesis and check for any contraindication to device implantation. Image analysis is divided into four steps that include analysis of the approach; search for a thrombus in the LAA; investigation of the anatomy of the LAA (morphology of the LAA, dimensions of the LAA and choice of device) and cardiac and thoracic assessments. Follow-up involves CT examination to check for correct placement of the device and to detect any complications. On the basis of the results of currently available published research, a panel of experts has issued recommendations regarding cardiac CT angiography prior to percutaneous LAA closure device placement, which were further endorsed by the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV).
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Affiliation(s)
- Vania Tacher
- Unité Inserm U955, Équipe 18, Université Paris Est, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France; Department of Radiology, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France.
| | - Islem Sifaoui
- Department of Radiology, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Rym Kharrat
- Department of Radiology, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Jean-Nicolas Dacher
- Inserm U1096, Department of Radiology, CHU de Rouen, Normandie University, UNIROUEN, 76000 Rouen, France
| | - Virgile Chevance
- Department of Radiology, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Romain Gallet
- Unité Inserm U955, Interventional Cardiology Department, Université Paris Est, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Emmanuel Teiger
- Unité Inserm U955, Interventional Cardiology Department, Université Paris Est, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Hicham Kobeiter
- Unité Inserm U955, Équipe 18, Université Paris Est, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France; Department of Radiology, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Vincent Le Pennec
- Department of Radiology, University Hospital of Caen, 14118 Caen, France
| | - Alexis Jacquier
- Department of Radiology and Cardiovascular Imaging, UMR 7339, CNRS, CRMBM-CEMEREM (Centre de Résonance Magnétique Biologique et Médicale-Centre d'Exploration Métaboliques par Résonance Magnétique), Aix-Marseille Université, 13000 Marseille, France
| | - Damien Mandry
- Department of Radiology, CHRU Nancy and Université de Lorraine, 54000 Nancy, France
| | - Laurent Macron
- Department of Radiology, Centre Cardiologique du Nord, 93000 Saint-Denis, France
| | - Haytham Derbel
- Unité Inserm U955, Équipe 18, Université Paris Est, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France; Department of Radiology, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Jean-François Deux
- Unité Inserm U955, Équipe 18, Université Paris Est, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France; Department of Radiology, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
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Kany S, Bordignon S, Piorkowski M, Chen S, Chun K, Tohoku S, Schmidt B. Retrieval of embolised left atrial appendage closure devices. EUROINTERVENTION 2021; 17:e178-e180. [PMID: 32310128 PMCID: PMC9724838 DOI: 10.4244/eij-d-19-01088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Shinwan Kany
- Cardioangiologisches Centrum Bethanien (CCB), Markus-Krankenhaus, Wilhelm-Epstein-Str 4, 60431 Frankfurt/Main, Germany
| | | | | | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Frankfurt/Main, Germany
| | - K.R. Chun
- Cardioangiologisches Centrum Bethanien, Frankfurt/Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Frankfurt/Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431 Frankfurt am Main, Germany
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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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Martinez-Dolz L, Pajares A, López-Cantero M, Osca J, Díez JL, Paniagua P, Argente P, Arana E, Alonso C, Rodriguez T, Vicente R, Anguita M, Alvarez J. Consensus document for anaesthesiologist-assisted sedation in interventional cardiology procedures. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:309-337. [PMID: 33931263 DOI: 10.1016/j.redar.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/01/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Affiliation(s)
- L Martinez-Dolz
- Servicio de Cardiología, Hospital Universitari i Politècnic La Fe. IIS La Fe. CIBERCV, Valencia, España.
| | - A Pajares
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - M López-Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - J Osca
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - J L Díez
- Unidad de Hemodinámica, Servicio de Cardiología del Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - P Paniagua
- Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - P Argente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - E Arana
- Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen del Rocío, Sevilla, España
| | - C Alonso
- Unidad de Arritmias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - T Rodriguez
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, España
| | - R Vicente
- Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe. IIS La Fe, Valencia, España
| | - M Anguita
- Servicio de Cardiología, Hospital Reina Sofía de Córdoba., Córdoba, España
| | - J Alvarez
- Servicio Anestesia y Reanimación. Complejo Hospitalario Universitario de Santiago. Universidad de Santiago, Santiago de Compostela, España
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Freixa X, Tzikas A, Aminian A, Flores-Umanzor E, De Backer O, Korsholm K, Ben Yedder M, Gonzalez-Ferreiro R, Agudelo-Montañez V, Gilhofer T, Simon F, Samaras A, Regueiro A, Sondergaard L, Cruz-Gonzalez I, Arzamendi D, Saw J, Ibrahim R, Nielsen-Kudsk JE. Left atrial appendage occlusion in chicken-wing anatomies: Imaging assessment, procedural, and clinical outcomes of the "sandwich technique". Catheter Cardiovasc Interv 2021; 97:E1025-E1032. [PMID: 33580751 DOI: 10.1002/ccd.29546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/29/2020] [Accepted: 01/18/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To describe imaging assessment, procedural and follow-up outcome of patients undergoing left atrial appendage (LAA) occlusion (LAAO) using a "sandwich" technique. BACKGROUND The presence of a LAA with chicken wing morphology constitutes a challenge that sometimes requires specific occlusion strategies like the "sandwich" technique. However, procedural and follow-up data focusing on this implanting strategy is scarce. METHODS This multicenter study collected individual data from eight centers between 2012 and 2019. Consecutive patients with chicken-wing LAAs defined as an early (<20 mm from the ostium) and severe bend (>90°) who underwent LAAO with Amplatzer devices and using the "sandwich" technique were included in the analysis. RESULTS Overall, 190 subjects were enrolled in the study. Procedures were done with the Amulet device (85%) and the Amplatzer Cardiac Plug (15%). Successful implantation was achieved in 99.5% with ≤1 partial recapture in 80% of cases. Single (46.2%) and dual antiplatelet therapy (39.4%) were the most used antithrombotic therapies after LAAO. In-hospital major adverse events rate was 1.5% with no deaths. One patient (0.5%) had cardiac tamponade requiring percutaneous drainage. With a mean follow-up of 19.6 ± 14.8 months, the mortality and stroke rates were 7.7%/year and 2.5%/year, respectively. Follow-up transesophageal echocardiography (TEE) at 2-3 months showed device-related thrombosis in 2.8% and peri-device leak ≥3 mm in 1.2% of patients. CONCLUSIONS In a large series of patients with chicken wing LAA anatomies undergoing LAAO, the use of the "sandwich" technique was feasible and safe. Preprocedural imaging was a key-factor to determine specific measurements.
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Affiliation(s)
- Xavier Freixa
- Hospital Clinic de Barcelona, Institut Clínic Cardiovascular, Barcelona, Spain
| | | | - Adel Aminian
- Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | | | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | | - Thomas Gilhofer
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Ander Regueiro
- Hospital Clinic de Barcelona, Institut Clínic Cardiovascular, Barcelona, Spain
| | | | | | | | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Reda Ibrahim
- Montreal Heart Institute, Montreal, Quebec, Canada
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Hildick-Smith D, Landmesser U, Camm AJ, Diener HC, Paul V, Schmidt B, Settergren M, Teiger E, Nielsen-Kudsk JE, Tondo C. Left atrial appendage occlusion with the Amplatzer™ Amulet™ device: full results of the prospective global observational study. Eur Heart J 2021; 41:2894-2901. [PMID: 32243499 DOI: 10.1093/eurheartj/ehaa169] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/24/2020] [Accepted: 02/26/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS To evaluate the safety and efficacy of left atrial appendage occlusion (LAAO) with the Amplatzer™ Amulet™ occluder. METHODS AND RESULTS Patients with atrial fibrillation eligible for LAAO were recruited to a prospective global study. Implant procedures were undertaken with echocardiographic guidance. Transoesophageal echocardiography (TOE) was undertaken 1-3 months post-LAAO. Implant and follow-up TOEs were evaluated by a CoreLab. The primary endpoint was a composite of ischaemic stroke and cardiovascular death at 2 years. Serious adverse events were adjudicated by an independent clinical events committee. A total of 1088 patients were enrolled, aged 75.2 ± 8.5 years; 64.5% were male. CHA2DS2-VASc and HAS-BLED scores were 4.2 ± 1.6 and 3.3 ± 1.1, respectively. A total of 71.7% had prior major bleeding, and 82.8% had contraindications to oral anticoagulants. Implant success was 99.1%. Major adverse events (≤7 days post-procedure) occurred in 4.0%, including death (0.3%), stroke (0.4%), major vascular (1.3%), and device embolization (0.2%). A total of 80.2% of patients were discharged on antiplatelet therapy alone. Peridevice flow was <3 mm in 98.4% at follow-up TOE. Device-related thrombus (DRT) was seen in 1.6% of cases. Cardiovascular death or ischaemic stroke occurred in 8.7% of patients at 2 years. The ischaemic stroke rate was 2.2%/year-a 67% reduction compared to the CHA2DS2-VASc predicted rate. Major bleeding (Bleeding Academic Research Consortium type ≥ 3) occurred at rates of 10.1%/year (year 1) and 4.0%/year (year 2). CONCLUSION Following LAAO with the Amplatzer Amulet device, the ischaemic stroke rate was reduced by 67% compared to the predicted risk. Closure was complete in 98.4% of cases and DRT seen in only 1.6%.
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Affiliation(s)
- David Hildick-Smith
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, 177 Preston Rd, Brighton BN1 6AGE, UK
| | - Ulf Landmesser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Charitépl. 1, Berlin 10117, Germany
| | - A John Camm
- Cardiology Clinical Academic Group Molecular & Clinical Sciences Institute, St. George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK
| | | | - Vince Paul
- Department of Cardiology, Fiona Stanley Hospital, 11 Robin Warren Dr 6150, Perth, Australia
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein-Straße 4, Frankfurt 60431, Germany
| | - Magnus Settergren
- Department of Cardiology, Karolinska Universitetssjukhuset, Eugeniavägen 3, Solna 171 76, Stockholm, Sweden
| | - Emmanuel Teiger
- Department of Cardiology, University Hospital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Jens Erik Nielsen-Kudsk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Claudio Tondo
- Heart Rhythm Centre at Monzino Cardiac Center, IRCCS, Department of Clinical Sciences and Community Health, University of Milan, Via Francesco Sforza 35, Milan 20122, Italy
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Cimmino G, Loffredo FS, Gallinoro E, Prozzo D, Fabiani D, Cante L, Salerno G, Cappelli Bigazzi M, Golino P. Percutaneous Left Atrial Appendage Occlusion: An Emerging Option in Patients with Atrial Fibrillation at High Risk of Bleeding. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:444. [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [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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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.C.); (E.G.); (D.P.); (D.F.); (L.C.); (P.G.)
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (M.C.B.)
| | - Francesco S. Loffredo
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.C.); (E.G.); (D.P.); (D.F.); (L.C.); (P.G.)
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (M.C.B.)
- Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy
| | - Emanuele Gallinoro
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.C.); (E.G.); (D.P.); (D.F.); (L.C.); (P.G.)
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium
| | - Dario Prozzo
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.C.); (E.G.); (D.P.); (D.F.); (L.C.); (P.G.)
| | - Dario Fabiani
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.C.); (E.G.); (D.P.); (D.F.); (L.C.); (P.G.)
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (M.C.B.)
| | - Luigi Cante
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.C.); (E.G.); (D.P.); (D.F.); (L.C.); (P.G.)
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (M.C.B.)
| | - Gemma Salerno
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (M.C.B.)
| | | | - Paolo Golino
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.C.); (E.G.); (D.P.); (D.F.); (L.C.); (P.G.)
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; (G.S.); (M.C.B.)
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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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Llagostera-Martín M, Cubero-Gallego H, Mas-Stachurska A, Salvatella N, Sánchez-Carpintero A, Tizon-Marcos H, Garcia-Guimaraes M, Calvo-Fernandez A, Molina L, Vaquerizo B. Left Atrial Appendage Closure with a New Occluder Device: Efficacy, Safety and Mid-Term Performance. J Clin Med 2021; 10:1421. [PMID: 33915971 PMCID: PMC8036586 DOI: 10.3390/jcm10071421] [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] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/17/2021] [Accepted: 03/26/2021] [Indexed: 11/17/2022] Open
Abstract
The LAmbreTM device is a novel system designed for left atrial appendage closure (LAAC). First registries showed a high rate of device implantation success. However, few mid-term results are available. We present our 1- and 12-month follow-up results for this device. This prospective, single-center registry included consecutive patients with nonvalvular atrial fibrillation who underwent LAAC with the LAmbreTM device. Transesophageal echocardiography (TEE) was performed at 1-month follow-up. In total, 55 patients were included. The population was elderly (75 ± 9.4 years), with a high proportion of comorbidities. The mean CHA2DS2-VASc and HAS-BLED scores were 4.6 ± 1.6 and 3.9 ± 1.0, respectively. Previous history of a major bleeding event was present in 37 patients (67.3%). Procedural success was achieved in 54 patients (98.2%). Device success was achieved in 100% of patients in whom device implantation was attempted (54 patients). Major in-hospital device-related complications included mortality of one patient (1.8%) and pericardial tamponade in two patients (3.6%); the incidence of stroke was 0%. No thrombus or significant leaks (≥5 mm) were observed on 1-month TEE. At 12 months, adverse events were overall death (1.8%), transient ischemic attack/ischemic stroke (1.8%), and major bleeding events (Bleeding Academic Research Consortium (BARC) 3a and 3c; 11%). In this high-risk population, the LAmbreTM device seems to be a safe and effective option for LAAC with a remarkable mid-term performance.
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Affiliation(s)
- Marc Llagostera-Martín
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
| | - Hector Cubero-Gallego
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
| | - Aleksandra Mas-Stachurska
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
- Heart Diseases Biomedical Research Group (GREC), Hospital del Mar Medical Investigation Institute-IMIM, 08003 Barcelona, Spain
| | - Neus Salvatella
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
| | - Andrea Sánchez-Carpintero
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
| | - Helena Tizon-Marcos
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
- Heart Diseases Biomedical Research Group (GREC), Hospital del Mar Medical Investigation Institute-IMIM, 08003 Barcelona, Spain
| | - Marcos Garcia-Guimaraes
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
| | - Alicia Calvo-Fernandez
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
| | - Luis Molina
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
- Heart Diseases Biomedical Research Group (GREC), Hospital del Mar Medical Investigation Institute-IMIM, 08003 Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona-UAB, 08193 Barcelona, Spain
| | - Beatriz Vaquerizo
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (M.L.-M.); (H.C.-G.); (A.M.-S.); (N.S.); (A.S.-C.); (H.T.-M.); (M.G.-G.); (A.C.-F.); (L.M.)
- Heart Diseases Biomedical Research Group (GREC), Hospital del Mar Medical Investigation Institute-IMIM, 08003 Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona-UAB, 08193 Barcelona, Spain
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Piayda K, Hellhammer K, Nielsen-Kudsk JE, Schmidt B, Mazzone P, Berti S, Fischer S, Lund J, Montorfano M, Della Bella P, Gage R, Zeus T. Clinical outcomes of patients undergoing percutaneous left atrial appendage occlusion in general anaesthesia or conscious sedation: data from the prospective global Amplatzer Amulet Occluder Observational Study. BMJ Open 2021; 11:e040455. [PMID: 33762228 PMCID: PMC7993182 DOI: 10.1136/bmjopen-2020-040455] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of percutaneous left atrial appendage occlusion (LAAO) using conscious sedation (CS). BACKGROUND Several percutaneous structural heart disease interventions are safely and efficiently performed using CS instead of general anaesthesia (GA). This concept has not been evaluated in a large multicenter cohort of patients undergoing LAAO. METHODS Patients from the prospective, global Amplatzer Amulet Occluder Observational Study were divided into two groups (GA vs CS). Baseline information, periprocedural and postprocedural efficacy and complications, as well as outcomes through 7 days post implant were compared. RESULTS Patients undergoing transesophageal-guided implants were categorised by GA (n=607, 64%) or CS (n=342, 36%) usage. Mean age was 75 years in both groups. LAAO technical success was achieved in 99% of both groups. The procedure duration (GA: 35±22 min vs CS: 27±19 min, p<0.001), total amount of contrast medium (GA: 105±81 mL vs CS: 86±66 mL, p<0.001) and fluoroscopic time (GA: 13±9 min vs CS: 12±13 min, p<0.001) were less in CS cases. Procedure-related or device-related serious adverse events during the first 7 days were numerically higher in the CS group (GA: 4.9% vs CS: 7.6%, p=0.114). Peridevice residual flow was absent or ≤5 mm 1-3 months after the procedure in 99.7% of the GA and in 100% of the CS group (p=1.000). CONCLUSIONS In a large global study, LAAO with the Amplatzer Amulet occluder is safe and feasible using CS. Procedure duration and total amount of contrast were less with CS than GA cases. TRIAL REGISTRATION NUMBER NCT02447081; Results.
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Affiliation(s)
- Kerstin Piayda
- Department of Cardiology, Pneumology and Vascular Medicine, Heinrich Heine University Düsseldorf, Duesseldorf, Nordrhein-Westfalen, Germany
| | - Katharina Hellhammer
- Department of Cardiology, Pneumology and Vascular Medicine, Heinrich Heine University Düsseldorf, Duesseldorf, Nordrhein-Westfalen, Germany
| | | | - Boris Schmidt
- Department of Cardiology, Bethanien-Krankenhaus, Frankfurt am Main, Hessen, Germany
| | | | - Sergio Berti
- Department of Cardiology, Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanita Pubblica, Pisa, Toscana, Italy
| | - Sven Fischer
- Department of Cardiology, Harzklinikum Dorothea Christiane Erxleben GmbH, Quedlinburg, Sachsen-Anhalt, Germany
| | - Juha Lund
- Department of Cardiology, Turku University Hospital, Turku, Finland
| | - Matteo Montorfano
- Department of Interventional Cardiology, Istituto Scientifico Universitario San Raffaele, Milano, Lombardia, Italy
| | - Paolo Della Bella
- Department of Arrhythmology, San Raffaele Hospital, Milano, Lombardia, Italy
| | - Ryan Gage
- Structural Heart, Abbott Cardiovascular-St Paul, Saint Paul, Minnesota, USA
| | - Tobias Zeus
- Department of Cardiology, Pneumology and Vascular Medicine, Heinrich Heine University Düsseldorf, Duesseldorf, Nordrhein-Westfalen, Germany
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Freixa X, Cepas-Guillen P, Flores-Umanzor E, Regueiro A, Sanchis L, Fernandez-Valledor A, Brugaletta S, Carretero M, Vidal B, Masotti M, Martin-Yuste V, Roqué M, Sitges M, Sabaté M. Pulmonary ridge coverage and device-related thrombosis after left atrial appendage occlusion. EUROINTERVENTION 2021; 16:e1288-e1294. [PMID: 33164895 PMCID: PMC9725056 DOI: 10.4244/eij-d-20-00886] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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 evaluate the impact of pulmonary ridge (PR) coverage on both clinical and imaging follow-up outcomes in patients undergoing left atrial appendage occlusion (LAAO). METHODS AND RESULTS The study included consecutive patients with non-valvular atrial fibrillation who underwent LAAO with disc and lobe devices. Patients were classified into two groups according to the PR coverage. A total of 147 patients were included. Among these, the PR was covered in 109 (74%) and uncovered in 38 (26%). Successful implantation was achieved in 98.6%. No differences in procedural outcomes were observed between the groups. The rate of procedural major adverse events was 3% (only major bleedings and/or vascular access complications). No device embolisation, cardiac tamponade or in-hospital mortality was observed. After a mean follow-up of 1.77±2.2 years, the annualised ischaemic stroke and major bleeding rate was 1.3%/year and 6.5%/year, respectively, without differences between groups. At follow-up, patients with a covered PR presented a lower incidence of device-related thrombosis (DRT) (1%) than those with an uncovered PR (27%); p<0.001. In multivariable analysis, the presence of PR coverage emerged as an independent predictor of DRT. CONCLUSIONS Pulmonary ridge coverage was associated with a lower incidence of DRT after LAAO. Procedural and follow-up clinical outcomes did not differ between covered PR and uncovered PR patients.
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Affiliation(s)
- Xavier Freixa
- Hospital Clinic de Barcelona, c/ Villarroel 170, Escala 3 Planta 6, 08015 Barcelona, Spain
| | - Pedro Cepas-Guillen
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Eduardo Flores-Umanzor
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ander Regueiro
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Laura Sanchis
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Andrea Fernandez-Valledor
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maria Carretero
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Barbara Vidal
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Mónica Masotti
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Victoria Martin-Yuste
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain,Centre Hospitalier de Saintonge, Saintes, France
| | - Mercè Roqué
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Sitges
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Manel Sabaté
- Department of Cardiology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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Rashid HN, Layland J. Modification of the left atrial appendage and its role in stroke risk reduction with non-valvular atrial fibrillation. IJC HEART & VASCULATURE 2021; 32:100688. [PMID: 33354620 PMCID: PMC7744943 DOI: 10.1016/j.ijcha.2020.100688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/21/2020] [Accepted: 11/27/2020] [Indexed: 12/30/2022]
Abstract
Atrial fibrillation is one of the most common cardiovascular disorders encountered by clinicians in clinical practice. Patients with atrial fibrillation are at risk of cerebrovascular and systemic embolic events, which may be attenuated by commencement of anticoagulation therapy. Even so, due to extremely high bleeding risk certain patients may not be suitable for long-term anticoagulation therapy. The left atrial appendage is a common site for thrombus formation in patients with atrial fibrillation. Left atrial appendage exclusion, either surgical or percutaneous, has been performed to ostensibly reduce the risk of cerebrovascular events and potentially minimise or omit anticoagulation therapy in select patients. This review summarises the role of the left atrial appendage in cerebrovascular events, current evidence with modification of the left atrial appendage and future trials that may change practice with these procedures.
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Key Words
- ACC, American College of Cardiology
- AF, Atrial fibrillation
- AHA, American Heart Association
- Atrial fibrillation
- DRT, Device related thrombus
- ESC, European Society of Cardiology
- FDA, Food and Drug Administation
- HR, Hazard ratio
- LAA, Left atrial appendage
- LAAE, Left atrial appendage exclusion
- LGE, Late gadolinium enhancement
- Left atrial appendage occluder
- Left atrial appendage occlusion
- OAC, Oral anticoagulation
- OR, Odds ratio
- Stroke
- TOE, Trans-oesopheageal echocardiogram
- Thrombosis
- Watchman device
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Affiliation(s)
- Hashrul N. Rashid
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
- Department of Cardiovascular Research, Peninsula Health, Melbourne, Australia
| | - Jamie Layland
- Department of Cardiovascular Research, Peninsula Health, Melbourne, Australia
- Peninsula Clinical School, Monash University, Melbourne, Australia
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Abstract
PURPOSE OF REVIEW To review recent evidence evaluating the long-term safety and efficacy outcomes of left atrial appendage occlusion (LAAO), current guideline recommendations for LAAO use, performance of LAAO in comparison with direct oral anticoagulants (DOAC) and recently approved LAAO device. RECENT FINDINGS The last 18 months have been marked with increasing evidence of the utility of LAAO in patients who are not candidates for long-term oral anticoagulation (OAC). Long-term data from two continued access registries to PROTECT-AF and PREVAIL support LAAO as a safe and effective long-term anticoagulation therapy. This new evidence led to class IIb recommendation for LAAO in nonvalvular atrial fibrillation (NVAF) patients not eligible for long-term OAC. PRAGUE-17 randomized controlled trial showed LAAO is noninferior to DOAC lending support to use of this modality in current era. PINNACLE FLX trial showed improved implant success and adequate closure rate which led to the device's Food and Drug Administration approval. SUMMARY In conclusion, percutaneous LAAO appears to be a promising option for NVAF patients who are not candidates for long-term OAC in the current era. Further evidence guiding optimal patient selection and periprocedural antithrombotic regimen will help identify the patients who would benefit the most from this procedure.
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Affiliation(s)
- Moghniuddin Mohammed
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas
- Department of Biomedical and Health Informatics, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas
| | - Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas
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Long-Term Safety and Efficacy of Percutaneous Left Atrial Appendage Closure with the LAmbre Device. J Interv Cardiol 2020; 2020:6613683. [PMID: 33424491 PMCID: PMC7769662 DOI: 10.1155/2020/6613683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/28/2020] [Accepted: 12/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Left atrial appendage closure (LAAC) using the LAmbre device has been associated with prevention of stroke in patients with nonvalvular atrial fibrillation (AF). Here, we interrogated the long-term safety and efficacy of using the LAmbre device in percutaneous LAAC. Methods We analyzed 56 records of patients with nonvalvular AF undergoing LAAC procedures with the LAmbre device. We collected and analyzed the data to define the safety and efficacy of the LAmbre device implantation. Result The LAAC was successfully occluded in the 56 patients. Our data showed no serious residual leak or pericardial effusion occurred during the perioperative period. At a mean follow-up of 37.8 ± 23.5 months, there were 7.1%, 3.6%, and 3.6% rates of death, stroke, and device-related thrombus, respectively. There were no cases of severe residual leak or systemic embolism. Conclusion Taken together, we demonstrate that execution of LAAC with the LAmbre device has high procedural success and prevents AF-related stroke. However, further large-scale trials might be required to confirm our findings.
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Cruz-González I, Korsholm K, Trejo-Velasco B, Thambo JB, Mazzone P, Rioufol G, Grygier M, Möbius-Winkler S, Betts T, Meincke F, Sandri M, Schmidt B, Schmitz T, Nielsen-Kudsk JE. Procedural and Short-Term Results With the New Watchman FLX Left Atrial Appendage Occlusion Device. JACC Cardiovasc Interv 2020; 13:2732-2741. [DOI: 10.1016/j.jcin.2020.06.056] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/04/2020] [Accepted: 06/30/2020] [Indexed: 01/01/2023]
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