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Mahmoudi K, Galea R, Elhadad S, Temperli F, Sebag F, Gräni C, Rezine Z, Roten L, Landolff Q, Brugger N, Masri A, Räber L, Amabile N. Computed Tomography Scan Evidence for Left Atrial Appendage Short-Term Remodeling Following Percutaneous Occlusion: Impact of Device Oversizing. J Am Heart Assoc 2023; 12:e030037. [PMID: 37609989 PMCID: PMC10547351 DOI: 10.1161/jaha.123.030037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023]
Abstract
Background The interrelationships between left atrial appendage (LAA) dimensions and device following implantation are unknown. We aimed to analyze the impact of Watchman device implantation on LAA dimensions following its percutaneous closure and potential predictors of remodeling. Methods and Results All consecutive LAA closure procedures performed at 2 centers between November 2017 and December 2020 were included in the WATCH-DUAL (Watchman 2.5 Versus Watchman FLX in a Dual-Center Left Atrial Appendage Closure Cohort) registry. This study included patients who had pre- and postintervention computed tomography scan analysis. The LAA and device dimensions were measured in a centralized core lab by 3-dimensional computed tomography scan reconstruction methods, focusing on the device landing zone. This analysis included 104 patients (age, 76.0 [range, 72.0-83.0] years; 72% men; 53% Watchman FLX; 47% Watchman 2.5). The baseline characteristics were comparable between Watchman 2.5 and Watchman FLX groups, except for the higher use of oversizing in the latter group. The median delay for computed tomography control was 49 (range, 43-64) days. The landing zone area (median, 446 [range, 363-523] versus 290 [222-366] mm2; P<0.001) and minimal diameter (median, 23.0 [range, 20.7-24.8] versus 16.7 [14.7-19.4] mm; P<0.001) significantly increased after implantation. The absolute (median, 157 [range, 98-220] versus 85 [18-148] mm2, P<0.001) and relative (median, 50% [range, 32%-79%] versus 26% [4%-50%]; P<0.001) increases in landing zone area were more pronounced in patients with oversized device. Baseline LAA dimensions were smaller, landing zone eccentricity larger, and oversized device more frequent in patients with significant overexpansion compared with the others. Conclusions LAA dimensions increased at the site of the Watchman prosthesis after implantation, suggesting a local positive remodeling after the procedure. This phenomenon was more pronounced in the case of oversized devices.
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Affiliation(s)
- Khalil Mahmoudi
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
| | - Roberto Galea
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Simon Elhadad
- Cardiology Department, Centre Hospitalier Marne la Vallée, JossignyFrance
| | - Fabrice Temperli
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Frederic Sebag
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
| | - Christoph Gräni
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Zhor Rezine
- Cardiology Department, Centre Hospitalier Marne la Vallée, JossignyFrance
| | - Laurent Roten
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | | | - Nicolas Brugger
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Alaa Masri
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
| | - Lorenz Räber
- Cardiology Department, Inselspital, Bern University HospitalUniversity of BernSwitzerland
| | - Nicolas Amabile
- Cardiology DepartmentInstitut Mutualiste MontsourisParisFrance
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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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3
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Takaya Y, Nakayama R, Yokohama F, Toh N, Nakagawa K, Miyamoto M, Ito H. Left atrial appendage morphology with the progression of atrial fibrillation. PLoS One 2022; 17:e0278172. [PMID: 36449497 PMCID: PMC9710751 DOI: 10.1371/journal.pone.0278172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
Left atrial appendage (LAA) size is crucial for determining the indication of transcatheter LAA closure. The aim of this study was to evaluate the differences in LAA morphology according to the types of atrial fibrillation (AF). A total of 299 patients (mean age: 67 ± 13 years) who underwent transesophageal echocardiography (TEE) were included. Patients were classified into non-AF (n = 64), paroxysmal AF (n = 86), persistent AF (n = 87), or long-standing persistent AF (n = 62). LAA morphology, including LAA ostial diameter and depth, was assessed using TEE. Patients with long-standing persistent AF had larger LAA ostial diameter and depth and lower LAA flow velocity. The maximum LAA ostial diameter was 19 ± 4 mm in patients with non-AF, 21 ± 4 mm in patients with paroxysmal AF, 23 ± 5 mm in patients with persistent AF, and 26 ± 5 mm in patients with long-standing persistent AF. LAA ostial diameter was increased by 2 or 3 mm with the progression of AF. LAA ostial diameter was correlated with LA volume index (R = 0.37, P < 0.01) and the duration of continuous AF (R = 0.30, P < 0.01), but not with age or the period from the onset of AF. In conclusion, LAA size was increased with the progression of AF.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- * E-mail:
| | - Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fumi Yokohama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masakazu Miyamoto
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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4
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Galea R, Mahmoudi K, Gräni C, Elhadad S, Huber AT, Heg D, Siontis GCM, Brugger N, Sebag F, Windecker S, Valgimigli M, Landolff Q, Roten L, Amabile N, Räber L. Watchman FLX vs. Watchman 2.5 in a Dual-Center Left Atrial Appendage Closure Cohort: the WATCH-DUAL study. Europace 2022; 24:1441-1450. [PMID: 35253840 DOI: 10.1093/europace/euac021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS No studies have compared Watchman 2.5 (W2.5) with Watchman FLX (FLX) devices to date. We aimed at comparing the FLX with W2.5 devices with respect to clinical outcomes, left atrial appendage (LAA) sealing properties and device-related thrombus (DRT). METHODS AND RESULTS All consecutive left atrial appendage closure (LAAC) procedures performed at two European centres between November 2017 and February 2021 were included. Procedure-related complications and net adverse cardiovascular events (NACE) at 6 months after LAAC were recorded. At 45-day computed tomography (CT) follow-up, intra- (IDL) and peri- (PDL) device leak, residual patent neck area (RPNA), and DRT were assessed by a Corelab. Out of 144 LAAC consecutive procedures, 71 and 73 interventions were performed using W2.5 and FLX devices, respectively. There were no differences in terms of procedure-related complications (4.2% vs. 2.7%, P = 0.626). At 45-day CT, the FLX was associated with lower frequency of IDL [21.3% vs. 40.0%; P = 0.032; odds ratio (OR): 0.375; 95% confidence interval (CI): 0.160-0.876; P = 0.024], similar rate of PDL (29.5% vs. 42.0%; P = 0.170), and smaller RPNA [6 (0-36) vs. 40 (6-115) mm2; P = 0.001; OR: 0.240; 95% CI: 0.100-0.577; P = 0.001] compared with the W2.5 group. At 45 days, rate of DRT as detected by CT and/or transoesophageal echocardiography (TOE), was higher with W2.5 (6.0% vs. 0%, P = 0.045). At 6-month follow-up, NACE did not differ between groups. CONCLUSIONS In this cohort of consecutive LAACs, FLX as compared to W2.5, was associated with similar procedure-related complications and 6-month NACE, but with improved LAA neck coverage, and lower IDL and DRT.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Khalil Mahmoudi
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Simon Elhadad
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.,Cardiology Department, Jossigny, France
| | - Adrian T Huber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Frederic Sebag
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland.,Cardiocentro Ticino, Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Quentin Landolff
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
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5
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Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H, Naito S, Yamane T, Kimura M, Shiga T, Soejima K, Noda T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Kohsaka S, Mitamura H. JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias. J Arrhythm 2022; 38:1-30. [PMID: 35222748 PMCID: PMC8851582 DOI: 10.1002/joa3.12649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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6
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Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H, Naito S, Yamane T, Kimura M, Shiga T, Soejima K, Noda T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Kohsaka S, Mitamura H. JCS/JHRS 2021 Guideline Focused Update on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:337-363. [PMID: 34987141 DOI: 10.1253/circj.cj-21-0162] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
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7
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Isogai T, Agrawal A, Saad AM, Kuroda S, Shekhar S, Abushouk AI, Wazni OM, Hussein AA, Krishnaswamy A, Kapadia SR. Periprocedural and Short-Term Outcomes of Percutaneous Left Atrial Appendage Closure According to Type of Atrial Fibrillation. J Am Heart Assoc 2021; 10:e022124. [PMID: 34729996 PMCID: PMC8751924 DOI: 10.1161/jaha.121.022124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Ankit Agrawal
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Anas M Saad
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Shunsuke Kuroda
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Shashank Shekhar
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Abdelrahman I Abushouk
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Oussama M Wazni
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Ayman A Hussein
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
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8
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Zapata J, Paamoni A, Rinard B, Abdou A, Zimmer D, Letherer CC. The Watchman device for preventing stroke in patients with atrial fibrillation. JAAPA 2021; 34:33-38. [PMID: 34582384 DOI: 10.1097/01.jaa.0000769672.18363.3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Atrial fibrillation (AF) is one of the most common sustained dysrhythmias that increases in prevalence with age, and is associated with strokes that can lead to significant patient morbidity and mortality. AF prevalence is projected to double over the next 25 years, demonstrating the need for innovative and effective stroke prevention modalities. Two options are direct oral anticoagulants and left atrial appendage occlusion. This article discusses the Watchman device, a left atrial appendage occlusion device that provides an option for patients with contraindications for anticoagulation.
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Affiliation(s)
- James Zapata
- James Zapata practices in emergency medicine and is on the emergency medicine fellowship faculty at Arrowhead Regional Medical Center in Colton, Calif., is an adjunct professor of emergency medicine at Western University of Health Sciences in Pomona, Calif., and practices in correctional health at San Bernardino County (Calif.) Correctional Facilities. Arielle Paamoni practices in cardiology at Sherev Heart and Vascular Clinic in El Cajon, Calif. Benjamin Rinard practices in emergency medicine at St. Bernadine Medical Center in San Bernardino, Calif. Amir Abdou practices in primary care in Long Beach, Calif. Drew Zimmer practices in emergency medicine at John F. Kennedy Memorial Hospital in Indio, Calif. Cathy Chang Letherer is director of academic education and an associate professor at California Baptist University in Riverside, Calif. The authors have disclosed no potential conflicts of interest, financial or otherwise
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9
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Kany S, Brachmann J, Lewalter T, Akin I, Sievert H, Zeymer U, Ledwoch J, Ince H, Thomas D, Hochadel M, Senges J, Kirchhof P, Rillig A. Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry. Clin Res Cardiol 2021; 111:511-521. [PMID: 34043052 PMCID: PMC9054864 DOI: 10.1007/s00392-021-01874-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. METHODS Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). RESULTS A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02-2.72, p = 0.041). CONCLUSION Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality.
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Affiliation(s)
- Shinwan Kany
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Johannes Brachmann
- Department of Cardiology, Angiology and Pneumology, Coburg Hospital, Coburg, Germany
| | - Thorsten Lewalter
- Department of Medicine-Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | - Ibrahim Akin
- Department of Cardiology, University Hospital Mannheim, Mannheim, Germany
| | - Horst Sievert
- Cardio Vascular Centre, Frankfurt, Frankfurt/Main, Germany
| | - Uwe Zeymer
- Department of Cardiology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Jakob Ledwoch
- Department of Cardiology, Hospital Neuperlach, Munich, Germany
| | - Hüseyin Ince
- Department of Cardiology, University Hospital Rostock, Rostock, Germany
| | - Dierk Thomas
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jochen Senges
- Stiftung Für Herzinfarktforschung (IHF), Ludwigshafen, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
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10
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Musikantow DR, Shivamurthy P, Croft LB, Kawamura I, Turagam MK, Whang W, Dukkipati SR, Goldman ME, Reddy VY. Transcatheter embolic coils to treat peridevice leaks after left atrial appendage closure. Heart Rhythm 2021; 18:717-722. [PMID: 33549807 DOI: 10.1016/j.hrthm.2021.01.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/13/2021] [Accepted: 01/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Left atrial appendage closure (LAAC) has proven to be an effective alternative to long-term oral anticoagulation in the prevention of thromboembolic events in patients with atrial fibrillation. In a minority of patients, inadequate seal may result in persistent peridevice flow and inability of the appendage to fully thrombose, thereby representing a potential source for thromboembolism. OBJECTIVE The purpose of this study was to study the use of endovascular coiling of the appendage to address persistent peridevice leak in patients undergoing LAAC with the Watchman device. METHODS This is a retrospective single-center analysis involving patients who underwent placement of a LAAC device and returned for endovascular coiling to address persistent device leak between 2018 and 2020. Baseline characteristics, procedural outcomes, and follow-up echocardiograms were analyzed to demonstrate the feasibility and safety of this technique. RESULTS Patients (N = 20) were identified with a mean leak size of 3.8 ± 1.3 mm (range 2.5-7 mm), all of whom had a non-thrombosed appendage. Acute procedural success was achieved in 95% of patients. Complete or significant reduction in flow beyond the LAAC device was achieved in 61% and 33% of patients, respectively. The 1 procedure-related adverse event was a pericardial effusion before coil deployment, requiring percutaneous drainage. CONCLUSION The clinical impact of residual peridevice leak post-Watchman implantation is a matter of continuing investigation. However, appendage coiling represents a new therapeutic tool to address this potential source for thromboembolism. Further studies should address the clinical impact of this technique, including the safety of discontinuing anticoagulation after successful coiling.
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Affiliation(s)
- Daniel R Musikantow
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Poojita Shivamurthy
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lori B Croft
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Iwanari Kawamura
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mohit K Turagam
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - William Whang
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Srinivas R Dukkipati
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Martin E Goldman
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivek Y Reddy
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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11
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Matsuda Y, Masuda M, Asai M, Iida O, Okamoto S, Ishihara T, Nanto K, Kanda T, Tsujimura T, Hata Y, Uematsu H, Mano T. A new clinical risk score for predicting the prevalence of low-voltage areas in patients undergoing atrial fibrillation ablation. J Cardiovasc Electrophysiol 2020; 31:3150-3158. [PMID: 32966648 DOI: 10.1111/jce.14761] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/07/2020] [Accepted: 09/20/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Although the presence of left atrial low-voltage areas (LVAs) is strongly associated with the recurrence of atrial fibrillation (AF) after ablation, few methods are available to classify the prevalence of LVAs. The purpose of this study was to establish a risk score for predicting the prevalence of LVAs in patients undergoing ablation for AF. METHODS We enrolled 1004 consecutive patients who underwent initial ablation for AF (age, 68 ± 10 years old; female, 346 (34%); persistent AF, 513 (51%)). LVAs were deemed present when the voltage map after pulmonary vein isolation demonstrated low-voltage areas with a peak-to-peak bipolar voltage of <0.5 mV covering ≥5 cm2 of the left atrium. RESULTS LVAs were present in 206 (21%) patients. The SPEED score was obtained as the total number of independent predictors as identified on multivariate analysis, namely female sex (odds ratio [OR], 3.4 [95% confidence interval {CI} 2.2-5.2], p < .01), persistent AF (OR, 1.8 [95% CI, 1.1-3.0], p = .02), age ≥ 70 years (OR, 2.3 [95% CI, 1.5-3.4], p < .01), elevated brain natriuretic peptide ≥100 pg/ml or N-terminal probrain natriuretic peptide ≥400 pg/ml (OR, 1.7 [95% CI, 1.02-2.8], p = .04), and diabetes mellitus (OR, 1.8 [95% CI, 1.1-2.8], p = .02). LVAs were more frequent in patients with a higher SPEED score, and prevalence increased with each additional SPEED score point (OR, 2.4 [95% CI, 2.0-2.8], p < .01). CONCLUSION The SPEED score accurately predicts the prevalence of LVAs in patients undergoing ablation for AF.
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Affiliation(s)
- Yasuhiro Matsuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Mitsutoshi Asai
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Takashi Kanda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Takuya Tsujimura
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Hiroyuki Uematsu
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
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Aminian A, Al Hage E, Saw J. Are Patients With Long-Standing Persistent Atrial Fibrillation at Higher Risk With Left Atrial Appendage Occlusion? JACC Cardiovasc Interv 2019; 12:1027-1029. [DOI: 10.1016/j.jcin.2019.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
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