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Chatani R, Kubo S, Tasaka H, Sakata A, Yoshino M, Maruo T, Kadota K. Safety and feasibility of atrial fibrillation ablation after left atrial appendage closure: A single-center experience of the left atrial appendage closure first strategy. J Arrhythm 2024; 40:879-890. [PMID: 39139871 PMCID: PMC11317688 DOI: 10.1002/joa3.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/27/2024] [Accepted: 05/09/2024] [Indexed: 08/15/2024] Open
Abstract
Background Patients with atrial fibrillation (AF) who are not suitable for long-term anticoagulant therapy undergo percutaneous left atrial appendage closure (LAAC). The safety and feasibility of left atrial catheter ablation (CA) procedures after LAAC remain unclear. This study aimed to clarify the feasibility and safety of CA after LAAC, including in the early phase within 180 days. Methods Characteristics and clinical outcomes of 46 patients with AF who had undergone both CA and LAAC within 2 years (mean age, 72 years; 29 men) were compared between those who had undergone CA-first (31 patients) and LAAC-first (15 patients). Results The mean CHA₂DS₂-VASc and HAS-BLED scores were 4.8 and 3.3 points, respectively. The LAAC-first strategy was often used in patients with prior major bleeding and LAA thrombosis or sludge. In the LAAC-first group, the mean duration between both procedures was 212 days, and all LAAC-first patients, including seven patients in the early phase, could undergo CA without LAAC device-related complications; moreover, no cardiovascular adverse events were reported after both procedures (mean periods: 420 days). After CA post-LAAC, no device-related adverse events (device-related thrombosis, new peri-device leak appearance, peri-device leak increase, or device dislodgement) were observed, whereas, after LAAC post-CA, 3 new peri-device leak appearance events and 1 peri-device leak increase event were observed, especially patients who underwent LAAC in the early phase post-CA. Conclusion Based on single-center experience, left atrial CA in the presence of an LAAC device implanted including the early phase was safe and feasible.
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Affiliation(s)
- Ryuki Chatani
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Shunsuke Kubo
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Hiroshi Tasaka
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Atsushi Sakata
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Mitsuru Yoshino
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Takeshi Maruo
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Kazushige Kadota
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
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Soulaidopoulos S, Vlachakis PK, Sagris M, Dimitroglou Y, Tolis E, Theofilis P, Aznouridis K, Dimitriadis K, Drakopoulou M, Lozos V, Toutouzas K, Aggeli C, Tsioufis C. Whispers of the Cath lab: "Cases we would rather forget". JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39077985 DOI: 10.1002/jcu.23772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/21/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024]
Abstract
In the dynamic field of interventional cardiology, significant strides have been made in reducing periprocedural complications. Echocardiography, particularly transesophageal echocardiography, plays a key role in ensuring the safety and success of structural heart interventions. Its real-time imaging capabilities allow for precise monitoring of device positioning, deployment, and procedural outcomes. By adhering to established imaging protocols and acquiring standard imaging planes, periprocedural echocardiography has become an essential tool for the successful performance of many structural heart interventions. In this manuscript, we present a series of unusual yet significant complications that we encountered during structural interventional procedures in our catheter laboratory. These complications, detected through echocardiography, underscore the critical role of imaging guidance in recognizing, and addressing unforeseen challenges, such as device malposition, thrombus formation in cardiac chambers during structural heart interventions, and cardiac tamponade during transcatheter mitral valve procedures. Through these cases, we highlight the effectiveness of transesophageal echocardiography in promptly identifying complications, allowing for timely intervention and resolution.
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Affiliation(s)
- Stergios Soulaidopoulos
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayotis K Vlachakis
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marios Sagris
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Yannis Dimitroglou
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Tolis
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Theofilis
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Aznouridis
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriakos Dimitriadis
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Drakopoulou
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Lozos
- Hippokration Hospital, 1st Department of Cardiac Surgery, Athens, Greece
| | - Konstantinos Toutouzas
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantina Aggeli
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Landmesser U, Skurk C, Tzikas A, Falk V, Reddy VY, Windecker S. Left atrial appendage closure for stroke prevention in atrial fibrillation: current status and perspectives. Eur Heart J 2024:ehae398. [PMID: 39027946 DOI: 10.1093/eurheartj/ehae398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/18/2024] [Accepted: 06/12/2024] [Indexed: 07/20/2024] Open
Abstract
Atrial fibrillation (AF) is associated with an increased risk of stroke and systemic embolism, and the left atrial appendage (LAA) has been identified as a principal source of thromboembolism in these patients. While oral anticoagulation is the current standard of care, LAA closure (LAAC) emerges as an alternative or complementary treatment approach to reduce the risk of stroke or systemic embolism in patients with AF. Moderate-sized randomized clinical studies have provided data for the efficacy and safety of catheter-based LAAC, largely compared with vitamin K antagonists. LAA device iterations, advances in pre- and peri-procedural imaging, and implantation techniques continue to increase the efficacy and safety of LAAC. More data about efficacy and safety of LAAC have been collected, and several randomized clinical trials are currently underway to compare LAAC with best medical care (including non-vitamin K antagonist oral anticoagulants) in different clinical settings. Surgical LAAC in patients with AF undergoing cardiac surgery reduced the risk of stroke on background of anticoagulation therapy in the LAAOS III study. In this review, we describe the rapidly evolving field of LAAC and discuss recent clinical data, ongoing studies, open questions, and current limitations of LAAC.
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Affiliation(s)
- Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite (DHZC), Hindenburgdamm 30, 12203 Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
- Friede Springer Cardiovascular Prevention Center@Charité, Hindenburgdamm 30, 12203 Berlin, Germany
- DZHK Partner Site Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite (DHZC), Hindenburgdamm 30, 12203 Berlin, Germany
- DZHK Partner Site Berlin, Germany
| | - Apostolos Tzikas
- Second Department of Cardiology, Hippocratic University Hospital, Aristotle University of Thessaloniki Department of Cardiology, Interbalkan Medical Center, Pylaia, Thessaloniki, Greece
| | - Volkmar Falk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite (DHZC), Hindenburgdamm 30, 12203 Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
- Friede Springer Cardiovascular Prevention Center@Charité, Hindenburgdamm 30, 12203 Berlin, Germany
- DZHK Partner Site Berlin, Germany
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
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Ansari U, Brachmann J, Lewalter T, Zeymer U, Sievert H, Ledwoch J, Geist V, Hochadel M, Schneider S, Senges J, Akin I, Fastner C. LAA occlusion is effective and safe in very high-risk atrial fibrillation patients with prior stroke: results from the multicentre German LAARGE registry. Clin Res Cardiol 2024:10.1007/s00392-024-02376-8. [PMID: 38294498 DOI: 10.1007/s00392-024-02376-8] [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: 07/08/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Interventional left atrial appendage occlusion (LAAO) mitigates the risk of thromboembolic events in nonvalvular atrial fibrillation (AF) patients with contraindication for long-term oral anticoagulation (OAC). Patients with prior stroke have a relevantly increased risk of recurrent stroke, so the effectiveness of LAAO could be reduced in this specific very high-risk patient group. AIM This sub-study of the LAARGE registry investigates the effectiveness and safety of LAAO for secondary prevention in nonvalvular AF patients with a history of stroke. METHODS LAARGE is a prospective, non-randomised registry on the clinical reality of LAAO. The current sub-study employs data from index procedure and 1-year follow-up. Effectiveness and safety were assessed by documentation of all-cause mortality, non-fatal thromboembolism, procedure-related complications, and bleeding events. RESULTS A total of 638 patients were consecutively included from 38 hospitals in Germany and divided into two groups: 137 patients with a history of stroke (21.5%) and 501 patients without. Successful implantation was consistent between both groups (98.5% vs. 97.4%, p = NS), while peri-procedural MACCE and other complications were rare (0% vs. 0.6% and 4.4% vs. 4.0%, respectively; each p = NS). Kaplan-Meier estimate showed no significant difference in primary effectiveness outcome measure (freedom from all-cause death or non-fatal stroke) between both groups at follow-up (87.8% vs. 87.7%, p = NS). The incidence of transient ischemic attack or systemic embolism at follow-up was low (0% vs. 0.5% and 0.9% vs. 0%, respectively; each p = NS). Severe bleeding events after hospital discharge were rare (0% vs. 0.7%, p = NS). CONCLUSIONS Patients with prior stroke demonstrated similar effectiveness and safety profile for LAAO as compared to patients without prior stroke. LAAO could serve as a feasible alternative to OAC for secondary stroke prevention in this selected group of nonvalvular AF patients. CLINICALTRIALS GOV IDENTIFIER NCT02230748.
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Affiliation(s)
- Uzair Ansari
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Johannes Brachmann
- Department of Cardiology, Angiology, and Pneumology, Second Medical Clinic, Coburg Hospital, Coburg, Germany
- University of Split School of Medicine, Split, Croatia
| | - Thorsten Lewalter
- Department of Medicine, Cardiology, and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | - Uwe Zeymer
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Horst Sievert
- CardioVascular Center (CVC) Frankfurt, Frankfurt am Main, Germany
| | - Jakob Ledwoch
- Isar Herz Zentrum München, ISAR Klinikum, Munich, Germany
- Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, München Klinik Neuperlach, Munich, Germany
| | - Volker Geist
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Fastner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS), and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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5
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Tejman-Yarden S, Freidin D, Nagar N, Parmet Y, Abed M, Vazhgovsky O, Yogev D, Ganchrow BID D, Mazor-Drey E, Chatterji S, Beinart R, Barbash I, Guetta V, Goitein O. Virtual reality utilization for left atrial appendage occluder device size prediction. Heliyon 2023; 9:e14790. [PMID: 37089380 PMCID: PMC10114146 DOI: 10.1016/j.heliyon.2023.e14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 04/07/2023] Open
Abstract
Aim To explore the feasibility and accuracy of virtual reality (VR) derived from cardiac computed angiography (CCTA) data to predict left atrial appendage occlusion (LAAO) device size. Method Retrospective data of patients who underwent LAAO according to clinical indication were reviewed; all patients underwent a pre-procedural CCTA. Measurements of the left atrial appendage (LAA) orifice diameters by CCTA, VR, and transesophageal echocardiography (TEE) (acquired during the procedure) were compared to the implanted device size. The LAA perimeter was calculated using the Ramanujan approximation. Statistical analyses included Lin's Concordance Correlation Coefficient (ρ c ), the mean difference, and the mean square error (MSE). Results The sample was composed of 20 patients (mean age 75.7 ± 7.5 years, 60% males) who underwent successful LAAO insertion (ACP™ N = 8, Watchman™ N = 12). The CCTA, VR, and TEE maximal diameter ρ c was 0.52, 0.78 and 0.60, respectively with mean differences of +0.92 ± 4.0 mm, -1.12 ± 2.3 mm, and -3.45 ± 2.69 mm, respectively. The CCTA, VR, and TEE perimeter calculations ρ c were 0.49, 0.54, and 0.39 respectively with mean differences of +4.69 ± 11.5 mm, -9.88 ± 8.0 mm, and -16.79 ± 7.8 respectively. Discussion A VR visualization of the LAA ostium in different perspectives allows for a better understanding of its funnel-shaped structure. VR measurement of the maximal ostium diameter had the strongest correlation with the diameter of the inserted device. VR may thus provide new imaging possibilities for the evaluation of complex pre-procedural structures such as the LAA.
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Comparison of Adverse Events between Isolated Left Atrial Appendage Closure and Combined Catheter Ablation. J Clin Med 2023; 12:jcm12051824. [PMID: 36902610 PMCID: PMC10003199 DOI: 10.3390/jcm12051824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
(1) Background: This study aimed to investigate the effect of an additional catheter ablation (CA) procedure on the risk of post-procedure adverse events during CA combined with left atrial appendage closure (LAAC). (2) Methods: From July 2017 to February 2022, data from 361 patients with atrial fibrillation who underwent LAAC at our center were analyzed retrospectively. The adverse events were compared between CA + LAAC and LAAC-only groups. (3) Results: The incidence of device-related thrombus (DRT) and embolic events was significantly lower in the CA + LAAC group than in the LAAC-only group (p = 0.01 and 0.04, respectively). A logistic regression analysis revealed that the combined procedure served as a protective factor for DRT (OR = 0.09; 95% confidence interval: 0.01-0.89; p = 0.04). Based on a Cox regression analysis, the risk of embolism marginally increased in patients aged ≥65 years (HR = 7.49, 95% CI: 0.85-66.22 p = 0.07), whereas the combined procedure was found to be a protective factor (HR = 0.25, 95% CI: 0.07-0.87 p = 0.03). Further subgroup and interaction analyses revealed similar results. (4) Conclusions: The combined procedure may be associated with a lower rate of post-procedure DRT and embolization without a higher occurrence of other adverse events after LAAC. A risk-score-based prediction model was conducted, showing a good prediction performance.
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Zhu X, Li W, Chu H, Zhong L, Wang C, Li J, Liang P, Wang L, Shi L. Catheter ablation in combined procedures is associated with residual leaks. Front Cardiovasc Med 2023; 9:1091049. [PMID: 36818912 PMCID: PMC9928718 DOI: 10.3389/fcvm.2022.1091049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/28/2022] [Indexed: 02/05/2023] Open
Abstract
Objectives To compare patients with atrial fibrillation (AF) undergoing left atrial appendage closure (LAAC) with catheter ablation (CA) and those without CA. Background The CA of AF may cause ridge edema, which may affect the safety of LAAC. Methods Patients with AF (N = 98) who underwent LAAC (combined CA + LAAC procedure group; N = 51) or alone (LAAC group; N = 47) received pre-procedural, intra-procedural, and 6 week post-procedural transesophageal echocardiography (TEE). The depth and ostial diameter of LAA, device compression, residual leak, and ridge thickness were evaluated in the patients who had undergone combined and alone procedures, as well as images of LAA and primary clinical characteristics. Results A residual leak was identified in 27 patients at 6 weeks after implantation by TEE (19 in the combined procedures group and eight in the alone group; p = 0.04). The combined procedure group had a significantly higher rate of a new residual leak than the alone group (25.5 vs. 8.5%; p = 0.03). Meanwhile, compared with at the time of implant, a smaller amount of device compression ratio was significant after 6 weeks (22.44 ± 3.90 vs. 19.59 ± 5.39; p = 0.03). There was no significant difference between both groups in all-cause mortality, cardiovascular mortality, and TIA/stroke/system embolism. Conclusion The combined procedures of CA and LAAC for AF are feasible and safe; however, during the follow-up period, we found that the resolution of ridge edema caused by CA might cause an increased residual leak and a smaller device compression ratio.
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Affiliation(s)
- Xuefeng Zhu
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Wenjing Li
- Doppler Ultrasonic Department, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Hongxia Chu
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China,*Correspondence: Hongxia Chu ✉
| | - Lin Zhong
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China,Lin Zhong ✉
| | - Chunxiao Wang
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Jianping Li
- Doppler Ultrasonic Department, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Pingping Liang
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Lihong Wang
- Doppler Ultrasonic Department, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Lei Shi
- Doppler Ultrasonic Department, Yantai Yuhuangding Hospital, Yantai, Shandong, China
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8
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Yu Y, Zhang R, Chen YH, Wang T, Tang XL, Gong CQ, Shao Y, Wang Z, Wang YP, Li YG. Diagnostic value of real-time four-dimensional transesophageal echocardiography on the implant-related thrombus. Front Cardiovasc Med 2023; 10:1018877. [PMID: 36776262 PMCID: PMC9910832 DOI: 10.3389/fcvm.2023.1018877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
Objectives This study aims to evaluate the diagnostic value of real-time four-dimensional transesophageal echocardiography (RT4D-TEE) for implant-related thrombus (IRT). Methods We collected 1,125 patients with atrial fibrillation from May 2019 to February 2022 in our hospital. All patients accepted transesophageal echocardiography (TEE) examination to exclude any thrombi before the LAAC procedure. Results There were 760 patients with LAAC, 66 patients with CIED, and 299 patients without any implantations. A total of 40 patients with an established diagnosis of IRT were further analyzed. The accurate detection rate of IRT by RT4D-TEE was 4.8% (40/826), which was higher than 3.8% (31/826) by 2D-TEE (P = 0.004). No IRT was found on TEE in the rest of the 786 patients. These 40 patients were divided into LAAC (n = 23) and CIED (n = 17) groups according to the results of RT4D-TEE. In the LAAC group, IRT distributed on different parts of the LAA occluder surface, 91.3% (21/23) with clumps of thrombi, and 8.7% (2/23) with a thin layer of thrombi covering the surface of the occluder. In the CIED group, thrombi were seen attached to the leads in the right atrium and right ventricle. The thrombi were beaded in 17.6% (3/17), corded in 17.6% (3/17), and clotted in the remaining 64.7% (11/17) of cases. After adjusting the anticoagulant dosage and following up for 6 months, 20% (8/40) of cases were successfully resolved, 67.5% (27/40) became smaller, and 12.5% (5/40) showed no changes. Conclusion The accurate detection rate of IRT by RT4D-TEE was significantly higher than that by 2D-TEE. 2D-TEE has limitations, but RT4D-TEE can be used as an effective complementary method. Imaging and some clinical features differ significantly between IRT on occluder and IRT on CIED lead.
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Affiliation(s)
- Yi Yu
- 1Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China,*Correspondence: Yi Yu,
| | - Rui Zhang
- 1Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Han Chen
- 1Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Wang
- 1Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Li Tang
- 1Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chang-qi Gong
- 1Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yun Shao
- 1Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Wang
- 2Department of Rehabilitation Medicine, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Yue-Peng Wang
- 1Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Yue-Peng Wang,
| | - Yi-Gang Li
- 1Department of Cardiology, Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Yi-Gang Li,
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9
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Ranard LS, Vahl TP, Sommer R, Ng V, Leb J, Lehenbauer K, Sitticharoenchai P, Khalique O, Hamid N, De Beule M, Bavo A, Hahn RT. FEops HEARTguide Patient-Specific Computational Simulations for WATCHMAN FLX Left Atrial Appendage Closure: A Retrospective Study. JACC. ADVANCES 2022; 1:100139. [PMID: 38939468 PMCID: PMC11198077 DOI: 10.1016/j.jacadv.2022.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 06/29/2024]
Abstract
Background Three-dimensional transesophageal echocardiography (3D-TEE) is the primary imaging tool for left atrial appendage closure planning. The utility of cardiac computed tomography angiography (CCTA) and patient-specific computational models is unknown. Objectives The purpose of this study was to evaluate the accuracy of the FEops HEARTguide patient-specific computational modeling in predicting appropriate device size, location, and compression of the WATCHMAN FLX compared to intraprocedural 3D-TEE. Methods Patients with both preprocedural and postprocedural CCTA and 3D-TEE imaging of the LAA who received a WATCHMAN FLX left atrial appendage closure device were studied (n = 22). The FEops HEARTguide platform used baseline CCTA imaging to generate a prediction of device size(s), device position(s), and device dimensions. Blinded (without knowledge of implanted device size/position) and unblinded (implant device size/position disclosed) simulations were evaluated. Results In 16 (72.7%) patients, the blind simulation predicted the final implanted device size. In these patients, the 3D-TEE measurements were not significantly different and had excellent correlation (Pearson correlation coefficient (r) ≥ 0.90). No patients had peridevice leak after device implant. In the 6 patients for whom the model did not predict the implanted device size, a larger device size was ultimately implanted as per operator preference. The model measurements of the unblinded patients demonstrated excellent correlation with 3D-TEE. Conclusions This is the first study to demonstrate that the FEops HEARTguide model accurately predicts WATCHMAN FLX device implantation characteristics. Future studies are needed to evaluate if computational modeling can improve confidence in sizing, positioning, and compression of the device without compromising technical success.
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Affiliation(s)
- Lauren S. Ranard
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Torsten P. Vahl
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Robert Sommer
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Vivian Ng
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Jay Leb
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Kyle Lehenbauer
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Patita Sitticharoenchai
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Omar Khalique
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Nadira Hamid
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Rebecca T. Hahn
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
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10
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Clinical benefit of left atrial appendage closure in octogenarians. J Geriatr Cardiol 2021; 18:886-896. [PMID: 34908926 PMCID: PMC8648545 DOI: 10.11909/j.issn.1671-5411.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Whether left atrial appendage closure (LAAC) in octogenarians yield similar net clinical benefit compared to younger patients, was the purpose of the present study. METHODS Two real-world LAAC registries, enrolling 744 consecutive Amplatzer and Watchman patients from 2009 to 2018, were retrospectively analyzed. RESULTS All events are reported per 100 patient-years. Two hundred and sixty one octogenarians and 483 non-octogenarians with a mean follow-up of 1.7 ± 1.3 and 2.3 ± 1.6 years, and a total of 1,502 patient-years were included. Octogenarians had a higher risk for stroke (CHA2DS2-VASc score: 5.2 ± 1.2 vs. 4.3 ± 1.7, P < 0.0001) and bleeding (HAS-BLED score: 3.3 ± 0.8 vs. 3.1 ± 1.1, P = 0.001). The combined safety endpoint of major periprocedural complications and major bleeding events at follow-up was comparable (30/446, 6.7% vs. 47/1056, 4.4%; hazard ratio [HR] = 1.2; 95% confidence interval [CI]: 0.73-1.98;P = 0.48) between the groups. The efficacy endpoint of all-cause stroke, systemic embolism, and cardiovascular/unexplained death occurred more often in octogenarians (61/446, 13.7% vs. 80/1056, 7.6%; HR = 7.0; 95% CI: 4.53-10.93;P < 0.0001). Overall, octogenarians had a lower net clinical benefit, i.e., the composite of all above mentioned hazards, from LAAC compared to younger patients (82/446, 18.4% vs. 116/1056, 11.0%; HR = 4.6; 95% CI: 3.11-7.0;P < 0.0001). Compared to the anticipated stroke rate, the observed rate decreased by 41% in octogenarians and 53% in non-octogenarians. The observed bleeding rate was reduced by 10% octogenarians and 41% non-octogenarians. CONCLUSIONS LAAC can be performed with similar safety in octogenarians as compared to younger patients. On the long-term, it both reduces stroke and bleeding events, although to a lesser extent than in non-octogenarians.
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11
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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: 5] [Impact Index Per Article: 1.7] [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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12
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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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13
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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: 43] [Impact Index Per Article: 14.3] [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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14
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Abdelghani E, Cua CL, Giver J, Rodriguez V. Thrombosis Prevention and Anticoagulation Management in the Pediatric Patient with Congenital Heart Disease. Cardiol Ther 2021; 10:325-348. [PMID: 34184214 PMCID: PMC8555036 DOI: 10.1007/s40119-021-00228-4] [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: 04/30/2021] [Indexed: 01/19/2023] Open
Abstract
Thrombosis is one of the most frequent complications affecting children with congenital heart disease (CHD). Palliative and reparative cardiac surgeries are some of the main players contributing to the thrombosis risk in this patient population. Additional risk factors related to the CHD itself (e.g., cardiac dysfunction, arrhythmias, and polycythemia in cyanotic cardiac disorders) can contribute to thrombogenicity alone or combined with other factors. Thrombotic complications have been recognized as a significant cause of morbidity and mortality in this patient population. Here, we provide an overview of the pathophysiology and risk factors for thrombosis as well as the indications for and use of different anticoagulation, antiplatelet, and thrombolytic agents. In addition, we describe some of most common thrombotic complications and their management in the pediatric CHD population.
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Affiliation(s)
- Eman Abdelghani
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Clifford L Cua
- Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA. .,Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
| | - Jean Giver
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Vilmarie Rodriguez
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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15
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Lee OH, Kim YD, Kim JS, Son NH, Pak HN, Joung B, Yu CW, Lee HJ, Kang WC, Shin ES, Choi RK, Lim DS, Jung YH, Choi HY, Lee KY, Cho BH, Han SW, Park JH, Cho HJ, Park HJ, Nam HS, Heo JH, So CY, Cheung GSH, Lam YY, Freixa X, Tzikas A, Jang Y, Park JW. Percutaneous Left Atrial Appendage Occlusion Yields Favorable Neurological Outcomes in Patients with Non-Valvular Atrial Fibrillation. Korean Circ J 2021; 51:626-638. [PMID: 34227275 PMCID: PMC8263298 DOI: 10.4070/kcj.2020.0527] [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: 12/14/2020] [Revised: 03/21/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Prior studies have shown that stroke patients treated with percutaneous left atrial appendage occlusion (LAAO) for non-valvular atrial fibrillation (NVAF) experience better outcomes than similar patients treated with warfarin. We investigated the impact of percutaneous left atrial appendage closure on post-stroke neurological outcomes in NVAF patients, compared with non-vitamin K antagonist oral anticoagulant (NOAC) therapy. METHODS Medical records for 1,427 patients in multiple registries and for 1,792 consecutive patients at 6 Korean hospitals were reviewed with respect to LAAO or NOAC treatment. Stroke severity in patients who experienced ischemic stroke or transient ischemic attack after either treatment was assessed with modified Rankin Scale (mRS) scoring at hospital discharge and at 3 and 12 months post-stroke. RESULTS mRS scores were significantly lower in LAAO patients at 3 (p<0.01) and 12 months (p<0.01) post-stroke, despite no significant differences in scores before the ischemic cerebrovascular event (p=0.22). The occurrences of disabling ischemic stroke in the LAAO and NOAC groups were 36.7% and 44.2% at discharge (p=0.47), 23.3% and 44.2% at 3 months post-stroke (p=0.04), and 13.3% and 43.0% at 12 months post-stroke (p=0.01), respectively. Recovery rates for disabling ischemic stroke at discharge to 12 months post-stroke were significantly higher for LAAO patients (50.0%) than for NOAC patients (5.6%) (p<0.01). CONCLUSIONS Percutaneous LAAO was associated with more favorable neurological outcomes after ischemic cerebrovascular event than NOAC treatment.
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Affiliation(s)
- Oh Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
| | - Jung Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Nak Hoon Son
- Data Science Team (Biostatistician), Center for Digital Health, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Hui Nam Pak
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Cheol Woong Yu
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Hyun Jong Lee
- Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Woong Chol Kang
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Eun Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Rak Kyeong Choi
- Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Do Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Yo Han Jung
- Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
| | - Hye Yeon Choi
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kyung Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Bang Hoon Cho
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Won Han
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Joong Hyun Park
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Han Jin Cho
- Department of Neurology, Pusan National University Hospital, Pusan National University College of Medicine and Biomedical Research Institute, Busan, Korea
| | - Hyung Jong Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Chak Yu So
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | | | - Yat Yin Lam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Xavier Freixa
- Department of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, Catalonia, Spain
| | - Apostolos Tzikas
- Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jai Wun Park
- Department of Cardiology, Charite University Hospital Campus Benjamin Franklin, Berlin, Germany
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16
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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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Kombinierte chirurgische Therapie des Vorhofflimmerns. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-020-00400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Burlacu A, Genovesi S, Artene B, Covic A. ' Will the king ever be dethroned?' The relationship and the future of oral anticoagulation therapy versus LAA closure devices. Expert Rev Cardiovasc Ther 2020; 19:1-4. [PMID: 33176513 DOI: 10.1080/14779072.2021.1850267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute , Iasi, Romania.,' Grigore T. Popa' University of Medicine , Iasi, Romania
| | - Simonetta Genovesi
- Department of Medicine and Surgery, University of Milan Bicocca and Nephrology Unit , Monza, Italy
| | - Bogdan Artene
- Department of Interventional Cardiology, Cardiovascular Diseases Institute , Iasi, Romania
| | - Adrian Covic
- ' Grigore T. Popa' University of Medicine , Iasi, Romania.,Nephrology Clinic, Dialysis, and Renal Transplant Center, 'C.I. Parhon' University Hospital , Iasi, Romania
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Kleinecke C, Gloekler S, Meier B. Utilization of percutaneous left atrial appendage closure in patients with atrial fibrillation: an update on patient outcomes. Expert Rev Cardiovasc Ther 2020; 18:517-530. [DOI: 10.1080/14779072.2020.1794820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Caroline Kleinecke
- Cardiology, Internal Medicine Department, Klinikum Lichtenfels, Lichtenfels, Germany
| | - Steffen Gloekler
- Cardiology, Internal Medicine Department, Klinikum Hochrhein, Waldshut-Tiengen, Germany and Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
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20
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Agarwal S, Pouyan A, Hreibe H. Transesophageal Echocardiographic Guidance in the Implantation of a Watchman Left Atrial Appendage Closure Device. A A Pract 2020; 14:e01309. [PMID: 32985846 DOI: 10.1213/xaa.0000000000001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Shvetank Agarwal
- From the Department of Anesthesiology and Perioperative Medicine
| | - Arman Pouyan
- Division of Cardiology, Augusta University, Augusta, Georgia
| | - Haitham Hreibe
- Division of Cardiology, Augusta University, Augusta, Georgia
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Glikson M, Wolff R, Hindricks G, Mandrola J, Camm AJ, Lip GYH, Fauchier L, Betts TR, Lewalter T, Saw J, Tzikas A, Sternik L, Nietlispach F, Berti S, Sievert H, Bertog S, Meier B. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion - an update. EUROINTERVENTION 2020; 15:1133-1180. [PMID: 31474583 DOI: 10.4244/eijy19m08_01] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Michael Glikson
- Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
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22
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Cruz-González I, Ince H, Kische S, Schmitz T, Schmidt B, Gori T, Foley D, de Potter T, Tschishow W, Vireca E, Stein K, Boersma LV. Cierre de orejuela izquierda en pacientes mayores de 85 años: seguridad y eficacia del registro EWOLUTION. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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23
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Nietlispach F, Bertel O. Surgical Bailout After TAVR: Rarely Needed-But Successful in Every Second Patient. JACC Cardiovasc Interv 2019; 12:1765-1767. [PMID: 31537277 DOI: 10.1016/j.jcin.2019.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/14/2019] [Accepted: 05/21/2019] [Indexed: 11/19/2022]
Affiliation(s)
| | - Osmund Bertel
- HerzGefaessZentrum, Hirslanden Klinik im Park, Zurich, Switzerland
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24
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Korsholm K, Jensen JM, Nørgaard BL, Nielsen-Kudsk JE. Detection of Device-Related Thrombosis Following Left Atrial Appendage Occlusion. Circ Cardiovasc Interv 2019; 12:e008112. [DOI: 10.1161/circinterventions.119.008112] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Device-related thrombosis (DRT) following left atrial appendage occlusion is a rare but feared complication. The diagnostic value of cardiac compute tomography (CT) for detection of DRT is unknown. This study sought to evaluate the clinical value of cardiac CT for detection of DRT using transesophageal echocardiography (TEE) as the reference standard and to provide insights into the causes, natural history, and risk of DRT.
Methods:
We reviewed 301 consecutive patients undergoing left atrial appendage occlusion at Aarhus University Hospital, Denmark, between 2010 and 2017. Of these, 248 patients had cardiac CT and TEE imaging available at 8-week follow-up; 139 had complete 12-month imaging. A blinded investigator analyzed all images. On TEE, an echo-dense mass attached to the device was defined as DRT. Cardiac CT was analyzed for presence of hypoattenuated thickening (HAT) on the device, which was subclassified as low grade or high grade. High-grade HAT was considered as definite DRT.
Results:
At 8 weeks, TEE detected 5 (2%) cases with DRT; and cardiac CT 6 (2.4%) cases with high-grade HAT. At 12 months, both TEE and cardiac CT detected 2 (1.4%) cases with DRT or high-grade HAT, respectively. Cardiac CT demonstrated low-grade HAT in 9 (3.6%) cases at 8 weeks; and 13 cases (9.4%) at 12-months. High-grade HAT/DRT was associated with thromboembolism in 2 cases, whereas low-grade HAT was not related to embolic events. Low-grade HAT resolved spontaneously over time.
Conclusions:
Cardiac CT seems equally good as TEE for detection of DRT. In addition, cardiac CT demonstrates cases with low-grade HAT, not visualized by TEE. The clinical significance hereof requires further investigation.
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Affiliation(s)
- Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Denmark
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25
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Glikson M, Wolff R, Hindricks G, Mandrola J, Camm AJ, Lip GYH, Fauchier L, Betts TR, Lewalter T, Saw J, Tzikas A, Sternik L, Nietlispach F, Berti S, Sievert H, Bertog S, Meier B, Lenarczyk R, Nielsen-Kudsk JE, Tilz R, Kalarus Z, Boveda S, Deneke T, Heinzel FR, Landmesser U, Hildick-Smith D. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update. Europace 2019; 22:184. [DOI: 10.1093/europace/euz258] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Michael Glikson
- Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Rafael Wolff
- Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Gerhard Hindricks
- Heartcenter Leipzig at Leipzig University and Leipzig Heart Institute, Department of Electrophysiology, Leipzig, Germany
| | | | - A John Camm
- Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, St. George’s University of London, London, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | - Tim R Betts
- Oxford University Hospitals NHS Foundation Trust, Oxford Biomedical Research Centre, Department of Cardiology, Oxford, United Kingdom
| | - Thorsten Lewalter
- Dept. of Cardiology and Intensive Care, Hospital for Internal Medicine Munich South, Munich, Germany
- Dept. of Cardiology, University of Bonn, Bonn, Germany
| | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Apostolos Tzikas
- Structural & Congenital Heart Disease, AHEPA University Hospital & Interbalkan European Medical Center, Thessaloniki, Greece
| | - Leonid Sternik
- Cardiac Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Fabian Nietlispach
- Cardiovascular Center Zurich, Hirslanden Klinik im Park, Zurich, Switzerland
| | - Sergio Berti
- Heart Hospital-Fondazione C.N.R. Reg. Toscana G. Monasterio, Cardiology Department, Massa, Italy
| | - Horst Sievert
- CardioVascular Center CVC, Cardiology and Angiology, Frankfurt, Germany
- Anglia Ruskin University, Chelmsford, United Kingdom
- University of California San Francisco, San Francisco, CA, USA
- Yunnan Hospital Fuwai, Kunming, China
| | - Stefan Bertog
- CardioVascular Center CVC, Cardiology and Angiology, Frankfurt, Germany
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital Bern, Bern, Switzerland
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Pracon R, Bangalore S, Dzielinska Z, Konka M, Kepka C, Kruk M, Kaczmarska-Dyrda E, Petryka-Mazurkiewicz J, Bujak S, Solecki M, Pskit A, Dabrowska A, Sieradzki B, Plonski A, Ruzyllo W, Witkowski A, Demkow M. Device Thrombosis After Percutaneous Left Atrial Appendage Occlusion Is Related to Patient and Procedural Characteristics but Not to Duration of Postimplantation Dual Antiplatelet Therapy. Circ Cardiovasc Interv 2019; 11:e005997. [PMID: 29463510 DOI: 10.1161/circinterventions.117.005997] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/26/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Device-related thrombus (DRT) after left atrial appendage occlusion is a worrisome finding with little knowledge about when to expect it and how to prevent it. This study sought to investigate correlates of DRT after left atrial appendage occlusion, its time of diagnosis, and particularly, association with postimplantation dual antiplatelet therapy duration. METHODS AND RESULTS Consecutive patients (n=102) after left atrial appendage occlusion with AMPLATZER Cardiac Plug/Amulet (n=59) or WATCHMAN (n=43) were included in a prospective registry (October 2011-May 2016). Follow-up was done at 1.5, 3 to 6, and 12 months postimplantation. DRT was classified as early (at 1.5 month), late (at 3-6 month), or very late (at 12-month follow-up). Postimplantation dual antiplatelet therapy was recommended for 30 to 180 days and decided independently by attending physicians. Final analysis included 99 patients, 42 (42.4%) females, with median CHA2DS2-VASc of 4.0 (interquartile range [IQR], 3.0-5.0) and median HAS-BLED score of 2.0 (IQR, 1.0-3.0). DRTs were observed in 7 (7.1%) patients: 2 (28.6%) early, 2 (28.6%) late, and 3 (42.9%) very late. When compared with patients without DRT, those with DRT presented more often with a history of prior thromboembolism (5 [71.4%] versus 28 [30.4%]; P=0.04), had lower left ventricular ejection fraction (50.0 [IQR, 35.0-55.0] versus 60.0 [IQR, 55.0-66.0]; P<0.01), and had greater proportion of patients with deep device implantation (6 [85.7%] versus 36 [39.1%]; P=0.04) and with larger devices implanted (30.0 mm [IQR, 27.0-33.0] versus 25.0 mm [IQR, 24.0-28.0]; P<0.01). Postimplantation dual antiplatelet therapy duration was not different between the 2 groups (12.4 weeks [IQR, 6.0-49.7] with DRT versus 13.0 weeks [IQR, 7.3-26.0] without DRT; P=0.77). CONCLUSIONS In this real-world series, DRT was observed early, late, and very late after left atrial appendage occlusion. It was related to patient and procedural characteristics but not to postimplantation dual antiplatelet therapy duration.
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Affiliation(s)
- Radoslaw Pracon
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.).
| | - Sripal Bangalore
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Zofia Dzielinska
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Marek Konka
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Cezary Kepka
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Mariusz Kruk
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Edyta Kaczmarska-Dyrda
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Joanna Petryka-Mazurkiewicz
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Sebastian Bujak
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Mateusz Solecki
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Agnieszka Pskit
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Agnieszka Dabrowska
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Bartosz Sieradzki
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Andrzej Plonski
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Witold Ruzyllo
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Adam Witkowski
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
| | - Marcin Demkow
- From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.)
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Fastner C, Nienaber CA, Park JW, Brachmann J, Zeymer U, Goedde M, Sievert H, Geist V, Lewalter T, Krapivsky A, Käunicke M, Maier J, Özdemir B, Hochadel M, Schneider S, Senges J, Akin I. Impact of left atrial appendage morphology on indication and procedural outcome after interventional occlusion: results from the prospective multicentre German LAARGE registry. EUROINTERVENTION 2019; 14:151-157. [PMID: 29508766 DOI: 10.4244/eij-d-17-00866] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Interventional left atrial appendage closure (LAAC) is an emerging alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) in concomitance with a contraindication for standard OAC. This sub-analysis of the LAARGE registry aimed to investigate differences between different LAA morphologies in a real-world setting. METHODS AND RESULTS This prospective, multicentre, observational registry included 562 patients from 37 centres with ineligibility for long-term OAC between April 2014 and January 2016. Baseline characteristics, indications, procedural data and complications were registered according to each LAA morphology (i.e., chicken wing, cauliflower, windsock, cactus and atypical morphologies). Implantation success was high across the four typical anatomies (≥97.5%, p=n.s.); only atypical anatomies exhibited a lower success rate (94%). The cactus-shaped LAA was linked to a trend indicating a shorter fluoroscopy time, while the atypical LAA was linked to a significantly prolonged fluoroscopy time (p=0.089 and p=0.025 versus the overall mean, respectively). Periprocedural and intra-hospital complications were generally rare, with no differences among the different morphologies (p=n.s.). CONCLUSIONS Procedural success as well as the complication rates of LAAC were not different among the four typical LAA morphologies. A lower implantation success rate was only obvious in patients with atypical LAA morphologies.
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Affiliation(s)
- Christian Fastner
- First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, University of Heidelberg, Mannheim, Germany
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Left atrial appendage orifice diameter measured with trans-esophageal echocardiography is independently related with peri-device leakage after Watchman device implantation. Int J Cardiovasc Imaging 2019; 35:1831-1839. [DOI: 10.1007/s10554-019-01625-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 05/06/2019] [Indexed: 12/16/2022]
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Han Z, Wu X, Chen Z, Ji W, Liu X, Liu Y, Di W, Li X, Yu H, Zhang X, Xu B, Lan RF, Xu W. Residual flow may increase the risk of adverse events in patients received combined catheter ablation and transcatheter left atrial appendage closure for nonvalvular atrial fibrillation: a meta-analysis. BMC Cardiovasc Disord 2019; 19:138. [PMID: 31182014 PMCID: PMC6558863 DOI: 10.1186/s12872-019-1123-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/31/2019] [Indexed: 01/29/2023] Open
Abstract
Background Catheter ablation (CA) and left atrial appendage closure (LAAC) have been combined into a novel one-stop procedure for patients with atrial fibrillation (AF). However, postoperative complications are relatively common in patients undergoing LAAC; the complications, including residual flow, increase in the risk of bleeding, or other adverse events, are unknown in patients receiving one-stop therapy. Therefore, we tried to evaluate the adverse events of CA and LAAC hybrid therapy in patients with nonvalvular AF. Methods We performed a meta-analysis and computer-based literature search to identify publications listed in the PubMed, Embase, and Cochrane library databases. Studies were included if patients received CA and LAAC hybrid therapy and reported adverse events. Results Overall 13 studies involving 952 patients were eligible based on the inclusion criteria. In the periprocedural period, the pooled incidence of pericardial effusion was 3.15%. The rates of bleeding events and residual flow were 5.02 and 9.11%, respectively. During follow-up, the rates of all-cause mortality, embolism events, bleeding events, AF recurrence, and residual flow were 2.15, 5.24, 6.95, 32.89, and 15.35%, respectively. The maximum occurrence probability of residual flow events was 21.87%. Bleeding events were more common in patients with a higher procedural residual flow event rate (P = 0.03). A higher AF recurrence rate indicated higher rates of embolism events (P = 0.04) and residual flow (P = 0.03) during follow-up. Conclusions Bleeding events were more common in patients with a higher procedural residual flow event rate. However, combined CA and LAAC therapy is reasonably safe and efficacious in patients with nonvalvular AF. Further studies on the safety and efficacy of CA or LAAC alone are necessary in future.
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Affiliation(s)
- Zhonglin Han
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China
| | - Xiang Wu
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China
| | - Zheng Chen
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China
| | - Wengqing Ji
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China
| | - Xuehua Liu
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China
| | - Yu Liu
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China
| | - Wencheng Di
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China
| | - Xiaohong Li
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China
| | - Hongsong Yu
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China
| | - Xinlin Zhang
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China
| | - Biao Xu
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China
| | - Rong Fang Lan
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China
| | - Wei Xu
- Department of Cardiology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Zhongshan Road No.321, Nanjing, 210000, China.
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Cruz-González I, Ince H, Kische S, Schmitz T, Schmidt B, Gori T, Foley D, de Potter T, Tschishow W, Vireca E, Stein K, Boersma LV. Left atrial appendage occlusion in patients older than 85 years. Safety and efficacy in the EWOLUTION registry. ACTA ACUST UNITED AC 2019; 73:21-27. [PMID: 30956034 DOI: 10.1016/j.rec.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/14/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Elderly patients with atrial fibrillation are at greater risk of both cardioembolic events and major bleeding than younger patients. Left atrial appendage occlusion (LAAO) could be an attractive alternative for these patients, but there are limited data on outcomes with LAAO in patients ≥ 85 years old. The aim of the present study was to assess the safety and efficacy of LAAO in patients ≥ 85 years old. METHODS A total of 1025 patients included in the EWOLUTION registry who underwent LAAO were analyzed and 84 patients ≥ 85 years old were identified and compared with the younger cohort. RESULTS Patients ≥ 85 years old had higher estimated stroke and hemorrhagic risks than younger patients (CHA2DS2-VASc: 5.2±1.2 vs 4.4±1.6, P <.0001; HAS-BLED: 2.7±1.1 vs 2.3±1.2; P=.003; ≥ 85 years vs <85 years). Procedural success was high and similar in both groups (98.8% vs 98.5%; P=.99). There were no differences in 7-day device- or procedure-related adverse event rates (2.6% in ≥ 85 years vs 3.1% in <85 years; P=.80). Despite the higher baseline stroke risk, there was no difference at follow-up between the groups in the annualized stroke rate (0.8/100 patient-years in ≥ 85 years vs 1.3/100 patient-years in <85 years; P=.649). CONCLUSIONS LAAO in patients ≥ 85 years is safe and effective even though these patients are at high risk for embolic and hemorrhagic events. LAAO may be a reasonable alternative to oral anticoagulation in these patients.
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Affiliation(s)
- Ignacio Cruz-González
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), Salamanca, Spain.
| | - Hueseyin Ince
- Kardiologie, Vivantes Klinikum Am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Stephan Kische
- Kardiologie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Thomas Schmitz
- Kardiologie, Elisabeth Krankenhaus Essen, Essen, Germany
| | - Boris Schmidt
- Kardiologie, Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Am Main, Germany
| | - Tommaso Gori
- Kardiologie, Universitätsmedizin Mainz und DZHK Standort Rhein-Main, Mainz, Germany
| | - David Foley
- Cardiology Deparment, Beaumont Hospital, Dublin, Ireland
| | - Tom de Potter
- Cardiologie, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
| | | | | | - Kenneth Stein
- Boston Scientific Corp, Minneapolis, Minessota, United States
| | - Lucas V Boersma
- Cardiologie, St Antonius Hospital, Nieuwegein, The Netherlands
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Abstract
Due to its high temporal and isotropic spatial resolution, CT has become firmly established for pre-procedural imaging in the context of structural heart disease interventions. CT allows to very exactly measure dimensions of the target structure, CT can provide information regarding the access route and, as a very valuable addition, volumetric CT data sets can be used to identify fluoroscopic projection angulations to optimally visualize the target structure and place devices. This review provides an overview of current methods and applications of pre-interventional CT to support adult cardiac interventions including transcatheter aortic valve implantation, percutaneous mitral valve intervention, left atrial appendage occlusion and paravalvular leak closure.
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) , Erlangen , Germany
| | - Stephan Achenbach
- Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) , Erlangen , Germany
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32
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Wang B, Zhang L, Sun W, He L, Wang X, Lv Q, Li Y, Xie M. Transnasal Transesophageal Echocardiography Guidance for Percutaneous Left Atrial Appendage Closure. Ann Thorac Surg 2019; 108:e161-e164. [PMID: 30807735 DOI: 10.1016/j.athoracsur.2019.01.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/05/2019] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
In the local anesthesia state, left atrial appendage closure cannot be accomplished under the real-time guidance of conventional transesophageal echocardiography because it induces significant discomfort for the patient. Transnasal transesophageal echocardiography can be well-tolerated by patients without general anesthesia for a prolonged examination time and can acquire excellent images. This case report describes the initially successful percutaneous left atrial appendage closure under the real-time guidance of transnasal transesophageal echocardiography without general anesthesia in a nonvalvular atrial fibrillation patient. The device covered the ostium of the left atrial appendage properly and stably, and there was no significant residual peridevice leak or device-associated thrombus postoperatively.
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Affiliation(s)
- Bin Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wei Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lin He
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xinfang Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
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Limpo B, López-Mínguez JR, Millán-Núñez MV, Fuentes-Cañamero ME, González-Fernández R, Nogales-Asensio JM. Trombosis tardía asociada a dispositivo de cierre percutáneo de orejuela. ¿Es poco frecuente o está infradiagnosticada? Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Li X, Li J, Chu H, Wang L, Shi L, Wang G, Wang X. Combination of catheter ablation for non-valvular atrial fibrillation and left atrial appendage occlusion in a single procedure. Exp Ther Med 2018; 16:2094-2100. [PMID: 30186445 DOI: 10.3892/etm.2018.6358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 05/11/2018] [Indexed: 12/18/2022] Open
Abstract
Patients with atrial fibrillation (AF) have an increased risk of stroke and systemic embolism. Catheter ablation (CA) is increasingly applied for the treatment for drug-refractory AF; however, its long-term success rate is <50%. It has been proved that percutaneous left atrial appendage occlusion (LAAO) exerts the same efficacy as novel oral anti-coagulants [(N)OACs] in reducing thromboembolic events. The present study investigated whether a combined procedure of AF ablation and LAAO may be feasible and efficacious. CA was performed for patients with AF and a high risk of stroke according to their CHADS2 or CHA2DS2-VASc score, and LAAO was performed using the Watchman device. A total of 25 patients (40% females; mean age, 64.2±3.5 years) who were treated between July 2016 and June 2017 were included in the present study. The median CHA2DS2-VASc score was 4.5 (range, 2-6) and the median HAS-BLED score was 3.17 (range, 1-7). Successful CA and LAAO were performed in 100% of cases. All patients met the criteria for successful LAAO. At the 6-month follow-up, complete sealing of the LAA was achieved in 23 patients (92%), while a minimal residual flow (<5 mm) was detected in 2 patients (8%). In 24 patients (96%), the administration of (N)OACs was terminated and aspirin administration was initiated at the 6-month follow-up. (N)OAC treatment was maintained in 1 patient (4%) on the basis of transient ischemic attack. During the 6-month follow-up period, 3 patients who had a recurrence of AF received a repeated ablation. In conclusion, the combination of CA and LAAO in a single procedure is feasible, safe and efficacious for patients with non-valvular AF at a high risk of stroke, and a contraindication regarding the use of (N)OACs.
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Affiliation(s)
- Xuexun Li
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Jianping Li
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Hongxia Chu
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Lihong Wang
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Lei Shi
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Guangqiang Wang
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Xiaofei Wang
- Department of Cardiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
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Lee OH, Kim JS, Pak HN, Hong GR, Shim CY, Uhm JS, Cho IJ, Joung B, Yu CW, Lee HJ, Kang WC, Shin ES, Choi RK, Lim DS, Jang Y. Feasibility of Left Atrial Appendage Occlusion for Left Atrial Appendage Thrombus in Patients With Persistent Atrial Fibrillation. Am J Cardiol 2018; 121:1534-1539. [PMID: 29631803 DOI: 10.1016/j.amjcard.2018.02.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/07/2018] [Accepted: 02/16/2018] [Indexed: 12/12/2022]
Abstract
This study sought to investigate the safety of percutaneous left atrial appendage (LAA) occlusion for stroke prevention in patients with nonvalvular atrial fibrillation who have LAA thrombus. From October 2010 to October 2016, LAA occlusions were performed in facilities within a Korean multicenter registry in patients without (n = 132) or with (n = 10) LAA thrombus (detected during preprocedural assessments). The incidences of periprocedural complications, including stroke, pericardial tamponade, major bleeding, and device embolization, were assessed and compared between the groups. The incidence of periprocedural complications was not significantly different between patients with and without LAA thrombus (0% vs 5% [6 of 132]; p = 0.49). During the mean 23.2 ± 17.5-month follow-up duration, 7 major adverse cardiac events occurred (1 cardiovascular death, 6 ischemic strokes), but overall event rates were not significantly different between the groups (14% vs 9%; p = 0.47). In conclusion, percutaneous LAA occlusion in nonvalvular atrial fibrillation patients with LAA thrombus may be a safe and feasible alternative to anticoagulation in select patients at a high risk of bleeding or contraindication to anticoagulation, or in whom anticoagulation failed to prevent stroke.
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36
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Weise FK, Bordignon S, Perrotta L, Konstantinou A, Bologna F, Nagase T, Chen S, Chun KJ, Schmidt B. Short-term dual antiplatelet therapy after interventional left atrial appendage closure with different devices. EUROINTERVENTION 2018; 13:e2138-e2146. [DOI: 10.4244/eij-d-17-00901] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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37
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Hanke T. Surgical management of the left atrial appendage: a must or a myth? Eur J Cardiothorac Surg 2018; 53:i33-i38. [DOI: 10.1093/ejcts/ezy088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/24/2018] [Indexed: 01/04/2023] Open
Affiliation(s)
- Thorsten Hanke
- Department for Cardiac Surgery, Asklepios Klinikum Harburg, Hamburg, Germany
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38
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Dar T, Turagam MK, Yarlagadda B, Tantary M, Sheldon SH, Lakkireddy D. Indication, Patient Selection, and Referral Pathways for Left Atrial Appendage Closure. Interv Cardiol Clin 2018. [PMID: 29526286 DOI: 10.1016/j.iccl.2017.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Left atrial appendage closure (LAAC) has emerged as a viable option for stroke prevention, especially in those intolerant of or not suitable for long-term oral anticoagulation therapy. This article describes the clinical characteristics, indications, and a proposed referral system for potential LAAC patients. Patient selection remains a challenge because of the paradox between the available randomized data on this intervention and the actual patient population who may gain maximum benefit. Further investigations comparing different LAAC devices with each other and with novel oral anticoagulants are needed. Also, the optimal antithrombotic regimen post-procedure has yet to be determined.
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Affiliation(s)
- Tawseef Dar
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Mohit K Turagam
- Division of Cardiology, Helmsey Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, 1190 5th Avenue, 1 South, New York, NY 10029, USA
| | - Bharath Yarlagadda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Mohmad Tantary
- Department of Internal Medicine, Clinch Valley Medical Center, 6801 Governor G C Peery Highway, Richlands, VA 24641, USA
| | - Seth H Sheldon
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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39
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Korsholm K, Jensen JM, Nielsen-Kudsk JE. Cardiac Computed Tomography for Left Atrial Appendage Occlusion: Acquisition, Analysis, Advantages, and Limitations. Interv Cardiol Clin 2018. [PMID: 29526291 DOI: 10.1016/j.iccl.2017.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Transcatheter left atrial appendage occlusion is increasingly used for stroke prevention in atrial fibrillation. The technique has proven effective and safe in randomized trials and multiple observational studies. The procedure is challenging due to the complex anatomy of the left atrial appendage; accurate cardiac imaging is essential for procedural guidance. Transesophageal echocardiography is the gold standard, but cardiac computed tomography (CT) has gained increasing interest within recent years. Cardiac CT offers high-resolution imaging allowing for preprocedural anatomic evaluation and device sizing, but may also be useful for exclusion of left atrial appendage thrombus, and follow-up assessment of residual peri-device leaks.
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Affiliation(s)
- Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N DK-8200, Denmark
| | - Jesper Møller Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N DK-8200, Denmark
| | - Jens Erik Nielsen-Kudsk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N DK-8200, Denmark.
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40
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Dieker W, Behnes M, Fastner C, Sartorius B, Wenke A, Sing-Gill I, El-Battrawy I, Kuschyk J, Papavassiliu T, Hoffmann U, Mashayekhi K, Schoenberg SO, Borggrefe M, Henzler T, Akin I. Impact of left atrial appendage morphology on thrombus formation after successful left atrial appendage occlusion: Assessment with cardiac-computed-tomography. Sci Rep 2018; 8:1670. [PMID: 29374188 PMCID: PMC5786001 DOI: 10.1038/s41598-018-19385-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/27/2017] [Indexed: 11/09/2022] Open
Abstract
A standardized imaging algorithm by cardiac computed tomography angiography (cCTA) (LOVE-view) was used in 30 patients to evaluate the influence of different left atrial appendage (LAA) morphologies on development of thrombosis in the LAA 6 months after implantation of an occlusion device (Watchman or Amplatzer-Cardiac-Plug) in patients with non-valvular atrial fibrillation, CHA2DS2-VASc-Score >1 and a contraindication for oral anticoagulation. The distribution of different LAA morphologies was 40% windsock, 17% broccoli and 43% chicken wing type. There was no significant difference in the level of thrombosis regarding LAA morphology or the type of chosen occlusion device. The rates of complete LAA thrombosis was 40% in broccoli type, 33% in windsock and 15% in chicken wing type. Independently of LAA type, 13% had none and 60% incomplete thrombosis. The ratio of density (LA/LAA) was 0.14 in patients with complete thrombosis and 0.67 in those with none or incomplete thrombosis. cCTA and the LOVE-view-imaging-algorithm were shown to be a valuable method for standardized imaging in clinical routine in a greater set of patients. Surprisingly thrombosis of the occluded LAA was still in progress in most cases at 6 months, whereas further studies are needed defining its clinical consequences, especially for the selection of the optimal post-procedural antithrombotic treatment strategy.
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Affiliation(s)
- Wulf Dieker
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christian Fastner
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Benjamin Sartorius
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Annika Wenke
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ishar Sing-Gill
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jürgen Kuschyk
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Theano Papavassiliu
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ursula Hoffmann
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany.
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
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41
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Aldana VG, Fernández A. Cierre percutáneo de la auriculilla izquierda en el manejo de la fibrilación auricular. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2017.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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42
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Masoud A, Bartoletti S, Fairbairn T, Khurana A, Velavan P, Morrison WL, Khalatbari A, Aggarwal S, Sharma N, Kirchhof P, Gupta D. Outcome of left atrial appendage occlusion in high-risk patients. Heart 2017; 104:594-599. [PMID: 29122931 DOI: 10.1136/heartjnl-2017-312383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Percutaneous left atrial appendage (LAA) occlusion can be an interventional alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation. METHODS We delivered LAA occlusion therapy using a standardised approach to patient referral, multidisciplinary team assessment, implant criteria, imaging and follow-up. We analysed patient characteristics, efficacy and safety of the implant procedure, and 12-month outcomes. RESULTS Of 143 referrals from October 2014 to December 2016, 83 patients (age 76±8years, 32.5% female, mean CHAD2S2-VASc score 4 ±1) were offered LAA occlusion. Eighty (95.3%) had previous major bleeding (intracranial in 59%). LAA occluder implantation with an Amulet device was successful in 82 (98.8%), with periprocedural major adverse events occurring in 5 (6.0%) patients (2 device embolisations including 1 death, 2 major bleeds). Cardiac imaging in 75 (94%) patients 2months following implant showed device-related thrombus in 1 case (1.3%) and minor (<5mm) device leaks in 13 (17.1%). Over a median 12-month follow-up, 3 (3.8%) ischaemic strokes, 2 (2.5%) haemorrhagic strokes and 5 (6.3%) major extracranial bleeds occurred. All-cause mortality was 10%, with most deaths (7, 87.5%) due to non-cardiovascular causes. CONCLUSIONS LAA occlusion may be a reasonable option for stroke prevention inhigh-risk patients with atrial fibrillation ineligible for anticoagulation. However, procedural complication rates are not insignificant, and patients remain at risk of serious adverse events and death even after successful implant.
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Affiliation(s)
- Ahmed Masoud
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.,Department of Cardiology, Benha University, Benha, Egypt
| | - Stefano Bartoletti
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Timothy Fairbairn
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Ayush Khurana
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Periaswamy Velavan
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | | | - Afshin Khalatbari
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Suneil Aggarwal
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Nikhill Sharma
- Department for Stroke, Gerontology and General Internal Medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
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43
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Hell M, Achenbach S, Yoo I, Franke J, Blachutzik F, Roether J, Graf V, Raaz-Schrauder D, Marwan M, Schlundt C. 3D printing for sizing left atrial appendage closure device: head-to-head comparison with computed tomography and transoesophageal echocardiography. EUROINTERVENTION 2017; 13:1234-1241. [DOI: 10.4244/eij-d-17-00359] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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44
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Nietlispach F, Moarof I, Taramasso M, Maisano F, Meier B. Left atrial appendage occlusion. EUROINTERVENTION 2017; 13:AA78-AA84. [DOI: 10.4244/eij-d-17-00412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Azizy O, Rammos C, Lehmann N, Rassaf T, Kälsch H. Percutaneous closure of the left atrial appendage in patients with diabetes mellitus. Diab Vasc Dis Res 2017; 14:407-414. [PMID: 28595459 DOI: 10.1177/1479164117712176] [Citation(s) in RCA: 5] [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] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Left atrial appendage closure is a preventive treatment of atrial fibrillation-related thrombo-embolism. Patients with diabetes mellitus have increased risk for a negative outcome in percutaneous cardiac interventions. We assessed whether percutaneous left atrial appendage closure is safe and effective in patients with diabetes mellitus. METHODS We included 78 patients (mean age of 74.4 ± 8.3 years) with indication for left atrial appendage closure in an open-label observational single-centre study. RESULTS Patients with diabetes mellitus ( n = 31) were at higher thrombo-embolic and bleeding risk (CHA2DS2-VASc: 4.5 ± 0.9, HAS-BLED: 4.7 ± 0.7) compared to patients without diabetes mellitus ( n = 47, CHA2DS2-VASc: 3.5 ± 1.0, HAS-BLED: 4.1 ± 0.8; p < 0.001 for both). Pre- and periprocedural risk was elevated in patients with diabetes mellitus (Euro II-Score: 6.6 ± 3.7 vs 3.9 ± 1.9, p < 0.01; Society of Thoracic Surgeons (STS)-Score: 4.0 ± 2.5 vs 2.6 ± 1.2, p < 0.01). Procedural success was similar. Periprocedural major adverse cardiac and cerebrovascular events occurred in one patient from the control group (2.1%), whereas patients with diabetes mellitus had no events ( p = 0.672). Follow-up of 6 months revealed no bleeding complication in both groups. No stroke occurred in follow-up, and left atrial appendage flow velocity reduction (55.6 ± 38.6 vs 51.4 ± 19.1 cm/s, p = 0.474) and rate of postinterventional leakage in the left atrial appendage were comparable (0% vs 2.1%, p = 0.672). CONCLUSION Despite patients with diabetes mellitus are high-risk patients, the outcome of percutaneous left atrial appendage closure is similar to patients without diabetes mellitus.
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Affiliation(s)
- Obayda Azizy
- 1 West-German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University of Duisburg-Essen, Essen, Germany
| | - Christos Rammos
- 1 West-German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University of Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- 2 Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- 1 West-German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University of Duisburg-Essen, Essen, Germany
| | - Hagen Kälsch
- 3 Department of Cardiology, Alfried Krupp Krankenhaus, Essen, Germany
- 4 Witten/Herdecke University, Witten, Germany
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Limpo B, López-Mínguez JR, Millán-Núñez MV, Fuentes-Cañamero ME, González-Fernández R, Nogales-Asensio JM. Late Thrombosis Associated With Left Atrial Appendage Closure Devices. Is It Rare or Is It Underdiagnosed? ACTA ACUST UNITED AC 2017; 71:767-769. [PMID: 28844829 DOI: 10.1016/j.rec.2017.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Bruno Limpo
- Servicio de Cardiología, Hospital Universitario Infanta Cristina, Badajoz, Spain
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Caliskan E, Cox JL, Holmes DR, Meier B, Lakkireddy DR, Falk V, Salzberg SP, Emmert MY. Interventional and surgical occlusion of the left atrial appendage. Nat Rev Cardiol 2017; 14:727-743. [DOI: 10.1038/nrcardio.2017.107] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Bergmann MW. LAA occluder device for stroke prevention: Data on WATCHMAN and other LAA occluders. Trends Cardiovasc Med 2017; 27:435-446. [PMID: 28461140 DOI: 10.1016/j.tcm.2017.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/10/2017] [Accepted: 03/20/2017] [Indexed: 01/01/2023]
Abstract
NOAC therapy has become the standard for stroke prevention in patients with atrial fibrillation. Yet some patients suffer extracranial bleeding events or have other reasons to seek non-pharmacologic stroke protection. LAA occlusion with the WATCHMAN device has been proven safe and effective for such patients and is now recommended in current guidelines for this patient group; other devices also seek approval.
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Fastner C, Behnes M, Sartorius B, Wenke A, El-Battrawy I, Ansari U, Gill IS, Borggrefe M, Akin I. Procedural success and intra-hospital outcome related to left atrial appendage morphology in patients that receive an interventional left atrial appendage closure. Clin Cardiol 2017; 40:566-574. [PMID: 28409845 DOI: 10.1002/clc.22699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/31/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The interventional left atrial appendage (LAA) closure represents an emerging alternative to oral anticoagulation for stroke prevention in certain atrial fibrillation patients. Preliminary results have suggested high procedural success rates and fewer peri-interventional complications; however, there persists an insufficient understanding of the role of many underlying confounding variables (e.g., anatomical characteristics). HYPOTHESIS It was investigated whether varying LAA morphologies influence procedural success as well as in-hospital outcome. METHODS Sixty-seven patients ineligible for long-term oral anticoagulation were included in this single-center, prospective, observational registry spanning from the years 2014 to 2016. Interventions were performed with the Watchman occluder (Boston Scientific, Natick, MA) or the Amplatzer Amulet (St. Jude Medical, St. Paul, MN), at the operator's discretion. Results derived from the data describing procedural success, fluoroscopy, and peri-interventional safety events were classified according to the presenting LAA morphology (cauliflower, cactus, windsock, and chicken wing). RESULTS Rates of successful implantation were high across all groups (≥98%; P = 0.326). Surrogate parameters underlining procedural complexity like median total duration (P = 0.415), median fluoroscopy time (P = 0.459), median dose area product (P = 0.698), and the median amount of contrast agent (P = 0.076) demonstrated similar results across all groups. Likewise, the periprocedural complication rate was not significantly different and was mainly restricted to minor bleeding events. CONCLUSIONS Irrespective of the varying morphological presentation of the LAA, the procedural success rates, interventional characteristics, and safety events did not significantly differ among patients receiving an interventional LAA closure.
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Affiliation(s)
- Christian Fastner
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Benjamin Sartorius
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Annika Wenke
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ishar-Singh Gill
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Jalal Z, Dinet ML, Combes N, Pillois X, Renou P, Sibon I, Iriart X, Thambo JB. Percutaneous left atrial appendage closure followed by single antiplatelet therapy: Short- and mid-term outcomes. Arch Cardiovasc Dis 2017; 110:242-249. [DOI: 10.1016/j.acvd.2016.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/15/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
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