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Yoon SH, Amoah JK, Galo J, Dallan LAP, Arruda M, Rashid I, Rajagopalan S, Filby SJ. Incidence, progression, and predictors of left atrial appendage sealing after Watchman FLX device implantation with computed tomographic assessment. Catheter Cardiovasc Interv 2024. [PMID: 38662126 DOI: 10.1002/ccd.31044] [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: 09/26/2023] [Revised: 02/13/2024] [Accepted: 03/31/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Limited data exists regarding incidence, progression, and predictors of left atrial appendage (LAA) sealing after transcatheter LAA closure. We aimed to evaluate the incidence, progression, and predictive factors associated with LAA sealing after LAA closure. METHODS This study includes patients who underwent successful LAA closure with Watchman FLX device and had both pre- and postprocedural computed tomography (CT). Postprocedural CT was performed 45 days after LAA closure and used to evaluate residual LAA patency. Patient who had residual LAA patency at 45 days underwent 1-year follow-up CT. RESULTS A total of 105 patients (mean age: 75.2 ± 9.6 years; 53.3% female) who underwent successful LAA closure with Watchman FLX device and had pre- and postprocedural CT at 45 days were included. Residual patency was observed in 35 (33.3%) patients: 21 (20.0%) patients showed complete contrast opacification in LAA (complete LAA patency) while 14 (13.3%) patients showed contrast opacification only in the distal LAA (distal LAA patency). Among patients with residual LAA patency at 45 days, the rate of LAA sealing at 1 year was significantly higher in the distal LAA patency group than in the complete LAA patency group (75.0% vs. 16.7%; p = 0.019). Increased depth oversizing was associated with both distal LAA patency and complete LAA patency. CONCLUSION Postprocedural CT at 45 days detected patent LAA in one-third of patients after LAA closure. LAA sealing was more frequently observed at 1 year among the distal LAA patency group than the complete LAA patency group.
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Affiliation(s)
- Sung-Han Yoon
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Medicine, Division of Structural Heart Disease, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Joseph Kofi Amoah
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jason Galo
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luis Augusto Palma Dallan
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mauricio Arruda
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Imran Rashid
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sanjay Rajagopalan
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Steven J Filby
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Galea R, Meneveau N, De Marco F, Aminian A, Heg D, Chalkou K, Gräni C, Anselme F, Franzone A, Vranckx P, Fischer U, Bedogni F, Räber L, Valgimigli M. One-Year Outcomes After Amulet or Watchman Device for Percutaneous Left Atrial Appendage Closure: A Prespecified Analysis of the SWISS-APERO Randomized Clinical Trial. Circulation 2024; 149:484-486. [PMID: 37875064 DOI: 10.1161/circulationaha.123.067599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Roberto Galea
- Departments of Cardiology (R.G., C.G., L.R., M.V.), CTU Bern, University of Bern, Switzerland
| | - Nicolas Meneveau
- Besancon University Hospital, University of Burgundy Franche-Comté, Besancon, France (N.M.)
| | - Federico De Marco
- Department of Cardiology, Monzino Cardiology Center, Milan, Italy (F.D.M.)
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Belgium (A.A.)
| | - Dik Heg
- Bern University Hospital, and Department of Clinical Research (D.H., K.C.), CTU Bern, University of Bern, Switzerland
| | - Konstantina Chalkou
- Bern University Hospital, and Department of Clinical Research (D.H., K.C.), CTU Bern, University of Bern, Switzerland
| | - Christoph Gräni
- Departments of Cardiology (R.G., C.G., L.R., M.V.), CTU Bern, University of Bern, Switzerland
| | - Frederic Anselme
- Department of Cardiology, University Hospital of Rouen, France (F.A.)
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University Federico II University, Naples, Italy (A.F.)
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium (P.V.)
- Faculty of Medicine and Life Sciences, Hasselt University, Belgium (P.V.)
| | - Urs Fischer
- Neurology (U.F.), CTU Bern, University of Bern, Switzerland
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy (F.B.)
| | - Lorenz Räber
- Departments of Cardiology (R.G., C.G., L.R., M.V.), CTU Bern, University of Bern, Switzerland
| | - Marco Valgimigli
- Departments of Cardiology (R.G., C.G., L.R., M.V.), CTU Bern, University of Bern, Switzerland
- Cardiocentro Ticino Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland (M.V.)
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3
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He YG, Yang SH, Xu L, Wang Y, Qin XT, Chen PP, Zhao YJ. The Effect of Peri-Device Leaks on Ischaemic Stroke/Transient Ischaemic Attack/Systemic Embolism after Left Atrial Appendage Closure: A Systematic Review and Meta-Analysis. Cardiology 2023; 148:581-592. [PMID: 37459844 DOI: 10.1159/000532019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 07/10/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Left atrial appendage closure (LAAC) is a safe and effective method for preventing embolic events in patients with non-valvular atrial fibrillation. However, peri-device leaks (PDLs) are sometimes unavoidable. Controversy exists regarding whether PDLs lead to embolic events. OBJECTIVES This study aimed to explore the association between PDLs and embolic events, including ischaemic stroke, transient ischaemic attacks (TIAs), and systemic embolism (SE). METHODS We conducted a systematic search of the PubMed, Web of Science, MEDLINE, and Cochrane Library databases for studies published up to September 25, 2022, to compare the rate of ischaemic stroke/TIA/SE between the PDL group and the non-PDL group after LAAC. RESULTS Thirteen studies comprising 54,405 patients were included in the meta-analysis. The PDL group detected by transoesophageal echocardiography (TEE) had a significantly higher rate of ischaemic stroke/TIA/SE than the non-PDL group (OR: 1.20, 95% CI: 1.08-1.33, p = 0.0009). However, no difference in ischaemic stroke/TIA/SE was found between the PDL and non-PDL subgroups of the cardiac computed tomography angiography (CCTA) group (OR: 1.12, 95% CI: 0.51-2.50, p = 0.77). CCTA and TEE showed different rates of PDL detection, with the CCTA group having a higher rate of PDL detection (p < 0.0001), especially for trivial leaks. CONCLUSIONS PDL detected by TEE increases the risk of embolic events after LAAC. However, no association was found between PDL and ischaemic stroke/TIA/SE in the CCTA group, which showed a higher rate of PDL detection than TEE, particularly for trivial leaks. In the future, CCTA may be used to explore the relationship between PDL size and ischaemic stroke/TIA/SE.
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Affiliation(s)
- Yin-Ge He
- Department of Cardiology, Zhengzhou No. 7 People's Hospital, Zhengzhou, China,
| | - Shao-Hua Yang
- Department of Cardiology, Zhengzhou No. 7 People's Hospital, Zhengzhou, China
| | - Liang Xu
- Department of Cardiology, Zhengzhou No. 7 People's Hospital, Zhengzhou, China
| | - Yan Wang
- Department of Cardiology, Zhengzhou No. 7 People's Hospital, Zhengzhou, China
| | - Xu-Tan Qin
- Department of Cardiology, Zhengzhou No. 7 People's Hospital, Zhengzhou, China
| | - Pan-Pan Chen
- Department of Cardiology, Zhengzhou No. 7 People's Hospital, Zhengzhou, China
| | - Yu-Jie Zhao
- Department of Cardiology, Zhengzhou No. 7 People's Hospital, Zhengzhou, China
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4
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Nestelberger T, Alfadhel M, McAlister C, Saw J. Follow Up imaging After Left Atrial Appendage Occlusion-Something or Nothing and for How Long? Card Electrophysiol Clin 2023; 15:157-168. [PMID: 37076228 DOI: 10.1016/j.ccep.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Routine postprocedural imaging with transesophageal echocardiography or cardiac computed tomography angiography is the most commonly used imaging modality for follow-up surveillance usually performed 1 to 6 months after the procedure. Imaging enables recognition of well-suited and sealed devices in the left atrial appendage as well as of potential harmful complications such as peri-device leaks, device-related thrombus, and device embolization, which may lead to further surveillance observation with recurrent imaging, reinitiation of oral anticoagulants, or additional interventional procedures.
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Affiliation(s)
- Thomas Nestelberger
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, 2775 Laurel Street, Level 9, Vancouver, BC V5Z1M9, Canada; Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mesfer Alfadhel
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, 2775 Laurel Street, Level 9, Vancouver, BC V5Z1M9, Canada
| | - Cameron McAlister
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, 2775 Laurel Street, Level 9, Vancouver, BC V5Z1M9, Canada
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, 2775 Laurel Street, Level 9, Vancouver, BC V5Z1M9, Canada; Vancouver General Hospital, Basel, British Columbia, Canada; University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, British Columbia V5Z 1M9, Canada.
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5
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Alkhouli M, De Backer O, Ellis CR, Nielsen-Kudsk JE, Sievert H, Natale A, Lakkireddy D, Holmes DR. Peridevice Leak After Left Atrial Appendage Occlusion: Incidence, Mechanisms, Clinical Impact, and Management. JACC Cardiovasc Interv 2023; 16:627-642. [PMID: 36990553 DOI: 10.1016/j.jcin.2022.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/11/2022] [Accepted: 12/05/2022] [Indexed: 03/31/2023]
Abstract
Left atrial appendage occlusion is an increasingly adopted stroke prevention strategy in patients with atrial fibrillation. However, peridevice leaks after the procedure are not infrequent and have recently been shown to confer a higher risk for subsequent ischemic events. In this paper, the authors review the available research on the frequency, mechanisms, clinical significance, and management of peridevice leak after percutaneous left atrial appendage occlusion.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine Rochester, Minnesota, USA.
| | - Ole De Backer
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - David R Holmes
- Department of Cardiology, Mayo Clinic School of Medicine Rochester, Minnesota, USA
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6
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Nestelberger T, Alfadhel M, McAlister C, Saw J. Follow Up imaging After Left Atrial Appendage Occlusion-Something or Nothing and for How Long? Interv Cardiol Clin 2022; 11:159-170. [PMID: 35361461 DOI: 10.1016/j.iccl.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Routine postprocedural imaging with transesophageal echocardiography or cardiac computed tomography angiography is the most commonly used imaging modality for follow-up surveillance usually performed 1 to 6 months after the procedure. Imaging enables recognition of well-suited and sealed devices in the left atrial appendage as well as of potential harmful complications such as peri-device leaks, device-related thrombus, and device embolization, which may lead to further surveillance observation with recurrent imaging, reinitiation of oral anticoagulants, or additional interventional procedures.
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Affiliation(s)
- Thomas Nestelberger
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, 2775 Laurel Street, Level 9, Vancouver, BC V5Z1M9, Canada; Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland; Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mesfer Alfadhel
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, 2775 Laurel Street, Level 9, Vancouver, BC V5Z1M9, Canada
| | - Cameron McAlister
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, 2775 Laurel Street, Level 9, Vancouver, BC V5Z1M9, Canada
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, 2775 Laurel Street, Level 9, Vancouver, BC V5Z1M9, Canada; Vancouver General Hospital, Basel, British Columbia, Canada; University of British Columbia, 2775 Laurel Street, 9th Floor, Vancouver, British Columbia V5Z 1M9, Canada.
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7
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Ranard LS, Guber K, Khalique OK, Leb J, Hamid N, Donald E, Hahn RT, Forman J, Ng V, Leon MB, Sommer R, Vahl TP. Improved Left Atrial Appendage Closure With the New-Generation WATCHMAN FLX by Cardiac Computed Tomography Angiography at 45 Days Postimplant. Circ Cardiovasc Interv 2022; 15:e011727. [PMID: 35313734 DOI: 10.1161/circinterventions.121.011727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lauren S Ranard
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Kenneth Guber
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Omar K Khalique
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Jay Leb
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Nadira Hamid
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Elena Donald
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Rebecca T Hahn
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Jessica Forman
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Vivian Ng
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Martin B Leon
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Robert Sommer
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Torsten P Vahl
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center
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8
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Computed tomography measurement for left atrial appendage closure. Cardiovasc Interv Ther 2022; 37:440-449. [DOI: 10.1007/s12928-022-00852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/02/2022]
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9
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Miller T, Hana D, Patibandla S, Guzman DB, Avalon JC, Zeb I, Kadiyala M, Mills J, Balla S, Kim C, Lisle M, Kawsara M, Raybuck B, Daggubati R, Sengupta PP, Hamirani YS. Cardiac computed tomography angiography for device related thrombus assessment after WATCHMAN FLX™ occluder device implantation: A single-center retrospective observational study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 41:35-46. [DOI: 10.1016/j.carrev.2022.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/03/2022]
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10
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Piayda K, Sievert K, Della Rocca D, Adeola O, Alkhouli M, Yoo D, Benito-González T, Cruz-González I, Galea R, Skurk C, De Backer O, Nielsen-Kudsk J, Grygier M, Beaty E, Newton J, Pérez de Prado A, Räber L, Gibson D, Van Niekerk C, Ellis C, Horton R, Natale A, Grundwald I, Zeus T, Sievert H. Safety and feasibility of peri-device leakage closure after LAAO: an international, multicentre collaborative study. EUROINTERVENTION 2021; 17:e1033-e1040. [PMID: 34219662 PMCID: PMC9724933 DOI: 10.4244/eij-d-21-00286] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Residual peri-device leakage (PDL) is frequent after left atrial appendage occlusion (LAAO). Little is known about management strategies, procedural aspects and outcomes of interventional PDL closure. AIMS The aim of this study was to assess the safety and feasibility of PDL closure after LAAO. METHODS Fifteen centres contributed data on baseline characteristics, in-hospital and follow-up outcomes of patients who underwent PDL closure after LAAO. Outcomes of interest included acute success and complication rates and long-term efficacy of the procedure. RESULTS A total of 95 patients were included and a cumulative number of 104 leaks were closed. The majority of PDLs were detected within 90 days (range 41-231). Detachable coils were the most frequent approach (42.3%), followed by the use of the AMPLATZER Vascular Plug II (29.8%) and the AMPLATZER Duct Occluder II (17.3%). Technical success was 100% with 94.2% of devices placed successfully within the first attempt. There were no major complications requiring surgical or transcatheter interventions. During follow-up (96 days [range 49-526]), persistent leaks were found in 18 patients (18.9%), yielding a functional success rate of 82.7%, although PDLs were significantly reduced in size (pre-leak sizemax: 6.1±3.6 mm vs post-leak sizemax: 2.5±1.3 mm, p<0.001). None of the patients had a leak >5 mm. Major adverse events during follow-up occurred in 5 patients (2 ischaemic strokes, 2 intracranial haemorrhages, and 1 major gastrointestinal bleeding). CONCLUSIONS Several interventional techniques have become available to achieve PDL closure. They are associated with high technical and functional success and low complication rates.
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Affiliation(s)
- Kerstin Piayda
- Cardiovascular Center (CVC) Frankfurt, Frankfurt, Germany
| | - Kolja Sievert
- Cardiovascular Center (CVC) Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | | | - Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | - Marek Grygier
- Poznan University of Medical Sciences, Poznan, Poland
| | - Elijah Beaty
- Wake Forest Baptist Health, Winston-Salem, NC, USA
| | | | | | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA,Scripps Health, La Jolla, CA, USA
| | | | - Tobias Zeus
- University Hospital Düsseldorf, Düsseldorf, Germany
| | - Horst Sievert
- CardioVascular Center (CVC) Frankfurt, Seckbacker Landstraβe 65, 60389 Frankfurt, Germany. E-mail:
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Galea R, De Marco F, Meneveau N, Aminian A, Anselme F, Gräni C, Huber AT, Teiger E, Iriart X, Babongo Bosombo F, Heg D, Franzone A, Vranckx P, Fischer U, Pedrazzini G, Bedogni F, Räber L, Valgimigli M. Amulet or Watchman Device for Percutaneous Left Atrial Appendage Closure: Primary Results of the SWISS-APERO Randomized Clinical Trial. Circulation 2021; 145:724-738. [PMID: 34747186 DOI: 10.1161/circulationaha.121.057859] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: No study has so far compared Amulet with the new Watchman FLX in terms of residual left atrial appendage (LAA) patency or clinical outcomes in patients undergoing percutaneous LAA closure (LAAC). Methods: In the investigator-initiated SWISS APERO trial, patients undergoing LAAC were randomized (1:1) open-label to receive Amulet or Watchman 2.5 or FLX (Watchman) across 8 European centres. The primary endpoint was the composite of justified crossover to a non-randomized device during LAAC procedure or residual LAA patency detected by cardiac computed tomography angiography (CCTA) at 45 days. The secondary endpoints included procedural complications, device related thrombus (DRT), peridevice leak (PDL) at transesophageal echocardiography (TEE) and clinical outcomes at 45 days. Results: Between June 2018, and May 2021, 221 patients were randomly assigned to Amulet (111 [50.2%]) or Watchman (110 [49.8%]), of whom 25 (22.7%) patients included before October 2019 received Watchman 2.5, and 85 (77.3%) patients received Watchman FLX. The primary endpoint was assessable in 205 (92.8%) patients and occurred in 71 (67.6%) Amulet and 70 (70.0%) Watchman patients respectively (risk ratio [RR] 0.97 [95% CI 0.80- 1.16]; P=0.713). A single justified cross-over occurred in an Amulet patient who fulfilled LAA patency criteria at 45-day CCTA. Major procedure related complications occurred more frequently in the Amulet group (9.0% vs. 2.7%; P=0.047), owing to more frequent bleeding (7.2% vs.1.8%). At 45 days, the PDL rate at TEE was higher with Watchman than Amulet (27.5% vs. 13.7%, p=0.020), albeit none was major (i.e. > 5 mm), whereas DRT was detected in 1 (0.9%) patient with Amulet and 3 (3.0%) patients with Watchman at CCTA and in 2 (2.1%) and 5 (5.5%) patients at TEE, respectively. Clinical outcomes at 45 days did not differ between the groups. Conclusions: Amulet was not associated with lower rate of the composite of crossover or residual LAA patency compared with Watchman at 45-day CCTA. Amulet, was however associated with lower PDL rates at TEE, higher procedural complications and similar clinical outcomes at 45 days compared with Watchman. The clinical relevance of CCTA-detected LAA patency requires further investigation. Clinical Trial Registration: URL https://clinicaltrials.gov Unique Identifier NCT03399851.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Nicolas Meneveau
- Besancon University Hospital, EA3920, University of Burgundy Franche-Comté, Besancon, France
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Frédéric Anselme
- Department of Cardiology, University Hospital of Rouen, Rouen, France
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Teiger
- Department of Cardiology, Henri-Mondor Hospital, Public Assistance Hospitals of Paris, Créteil, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Hôpital Cardiologique du Haut- Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Flora Babongo Bosombo
- Department of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Dik Heg
- Department of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University Federico II University, Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland and Department of Neurology, University Hospital Basel, University of Basel, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Cardiocentro Ticino Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland
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