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Bagga A, Sutherlin C, Makkar B, Green S, Vallabhaneni LL, Mitra C, Abdelrahman M, Balakrishnan M, Hantla J, Lakkireddy D, Makkar A. Outcomes of Left Atrial Appendage Occlusion Treatment With Amulet After Unsuccessful Watchman FLX Device: A Multicenter Observational Study. J Cardiovasc Electrophysiol 2025. [PMID: 40390276 DOI: 10.1111/jce.16729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Revised: 04/24/2025] [Accepted: 05/06/2025] [Indexed: 05/21/2025]
Abstract
INTRODUCTION Watchman FLX (W-FLX) is the most widely used left atrial appendage occlusion (LAAO) device to prevent atrial fibrillation (AF) related strokes in the United States. However, successful LAAO with W-FLX can be challenging in patients with complex left atrial appendage (LAA) anatomies. This analysis aimed to assess the procedural success rates of LAA occlusion (immediate and short-term outcomes) using the Amulet device, in patients with prior failed LAAO with W-FLX device. METHODS AND RESULTS This was a multicentric retrospective analysis of 62 consecutive patients with unsuccessful LAAO with W-FLX, who subsequently underwent an attempted Amulet occluder placement. The primary endpoint was successful Amulet implantation. Secondary endpoints included peri-device leak (PDL) and device-related thrombus assessed by transesophageal echocardiography (TEE) at 45 days, safety end point through 7 days or hospital discharge (whichever was later) and major adverse events (MAEs) through 45 days. The Amulet occluder was successfully implanted in 98.38% of patients (n = 61/62). No clinically relevant PDL or device-related thrombus was noted at 45 days. There was one pericardial effusion noted a week after Amulet implant that underwent successful percutaneous pericardiocentesis. The reasons for W-FLX failure were all anatomical in nature. We identified five distinct anatomical patterns that posed challenges for W-FLX deployment but were amenable to successful Amulet implantation. CONCLUSION The disc-lobe design of Amulet allows a high degree of successful LAAO in challenging anatomical variants (whale-tail, bilobed LAA, shallow vertical chicken-wing or seahorse, oval wide with posterior sloping trabeculations, and extensively trabeculated broccoli morphologies) with prior failed W-FLX implants. These findings may help guide device selection on pre-LAAO imaging, thereby enhancing resource utilization and contributing to more efficient and safer LAAO procedures.
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Affiliation(s)
- Arindam Bagga
- Arizona Heart Arrhythmia Associates, Phoenix, Arizona, USA
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Christian Sutherlin
- Arizona Heart Arrhythmia Associates, Phoenix, Arizona, USA
- Creighton University School of Medicine, Phoenix, Arizona, USA
| | - Bhavya Makkar
- Arizona Heart Arrhythmia Associates, Phoenix, Arizona, USA
- University of Arizona, Tucson, Arizona, USA
| | - Spencer Green
- Arizona Heart Arrhythmia Associates, Phoenix, Arizona, USA
- Creighton University School of Medicine, Phoenix, Arizona, USA
| | | | - Corinne Mitra
- Arizona Heart Arrhythmia Associates, Phoenix, Arizona, USA
| | | | | | - Jacob Hantla
- Arizona Anesthesia Solutions, Phoenix, Arizona, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Akash Makkar
- Arizona Heart Arrhythmia Associates, Phoenix, Arizona, USA
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Marmagkiolis K, Caballero J, Votsis S, Ninios V, Cilingiroglu M, Boudoulas KD, Iliescu C. Structural Heart Disease Interventions. Year in Review 2023-2024. Catheter Cardiovasc Interv 2025; 105:1196-1203. [PMID: 39910697 DOI: 10.1002/ccd.31436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 01/19/2025] [Accepted: 01/23/2025] [Indexed: 02/07/2025]
Abstract
In 2023-2024, there was a surge in research on structural heart disease. This review aims to provide a comprehensive overview of the field for both general and interventional cardiologists, especially those with a keen interest in structural heart interventions. It summarizes the most important randomized controlled trials, meta-analyses, retrospective analyses, data registries, and noteworthy late-breaking studies unveiled at prominent cardiology conferences.
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Affiliation(s)
- Konstantinos Marmagkiolis
- Department of Cardiology, Tampa General Hospital, University of South Florida, Tampa, Florida, USA
- Department of Cardiology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Jaime Caballero
- Department of Cardiology, Tampa General Hospital, University of South Florida, Tampa, Florida, USA
| | - Stefanos Votsis
- 424 Military Hospital, Thessaloniki, Greece
- Medical College of Georgia, Augusta, Georgia, USA
| | | | - Mehmet Cilingiroglu
- Department of Cardiology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | | | - Cezar Iliescu
- Department of Cardiology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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Jiang XH, Tan YJ, Wang RZ, Ruan ZB, Zhu L. Comparison of prognosis and analysis of related risk factors among three different left atrial appendage occlusion procedures in patients with atrial fibrillation. Front Cardiovasc Med 2025; 12:1534899. [PMID: 40034991 PMCID: PMC11872903 DOI: 10.3389/fcvm.2025.1534899] [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: 11/26/2024] [Accepted: 01/28/2025] [Indexed: 03/05/2025] Open
Abstract
Background Left atrial appendage occlusion (LAAO) serves as an alternative to oral anticoagulation (OAC) for atrial fibrillation (AF) patients at high risk of bleeding. The aim of this study was to compare the peri-procedural safety, complete or incomplete occlusion, the incidence of the peri-device leak (PDL), and device-related thrombosis (DRT) among LAAO, cryoballoon ablation (CBA) combined with LAAO, and radiofrequency catheter ablation (RFCA) combined with LAAO and to explore the risk factors of PDL and incomplete occlusion. Methods 382 patients with non-valvular AF who underwent either LAAO alone (n = 117), CBA combined with LAAO (n = 125), or RFCA combined with LAAO (n = 140) were included in the retrospective study. The study assessed peri-procedural complications and imaging results (3 months post-procedure). Multivariable logistic regression was employed to identify risk factors for incomplete occlusion and PDL. Results Peri-procedural complication rates were low among all groups, with 2.9% in the RFCA combined with the LAAO group. In contrast, the LAAO alone and CBA combined with LAAO groups reported no major complications (p = 0.347). At the 3-month follow-up, the incidence of DRT was 1.7% in the LAAO group, 2.4% in the CBA combined with the LAAO group, and 2.1% in the RFCA combined with the LAAO group (p = 0.930). Complete occlusion rates were comparable among the groups: 64.8% for CBA combined with LAAO, 62.4% for LAAO alone, and 60.7% for RFCA combined with LAAO (p = 0.794). PDL occurred in 33.3% of LAAO-alone patients, 34.4% of CBA combined with LAAO patients, and 38.6% of RFCA combined with LAAO patients (p = 0.644). Multivariable analysis identified persistent AF and serum creatinine (SCr) as independent predictors of PDL and incomplete occlusion. Conclusion Peri-procedural complications, complete occlusion, PDL, and DRT rates were similar across the three treatment strategies. Persistent AF and SCr were significant risk factors for incomplete occlusion and PDL. These findings highlight the importance of individualized treatment strategies based on patient-specific risk factors for optimizing outcomes.
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Affiliation(s)
- Xiao-hai Jiang
- Department of Cardiology, The affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
| | - Yan-juan Tan
- Postgraduate Training Base of Dalian Medical University, Taizhou People's Hospital, Taizhou, Jiangsu, China
| | - Run-zhong Wang
- Department of Cardiology, The affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
| | - Zhong-bao Ruan
- Department of Cardiology, The affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
| | - Li Zhu
- Department of Cardiology, The affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
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Shen J, Chen Y, Wang L, Wu S, Zhou H, Huang Z, Chen Y, Shi X, Chen X, Wu X, Xing J, Wang Z, Xiao F. Pulmonary Ridge Coverage: a Two-edged Sword in Left Atrial Appendage Closure With LAmbre. Can J Cardiol 2025:S0828-282X(25)00128-X. [PMID: 39954814 DOI: 10.1016/j.cjca.2025.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Revised: 01/16/2025] [Accepted: 02/05/2025] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND The LAmbre occluder, available in 2 versions, allows for selective coverage of the pulmonary ridge (PR) during left atrial appendage closure (LAAC). In this study we evaluated the effects of PR coverage on imaging and clinical outcomes in patients undergoing LAAC. METHODS Imaging data and clinical events were retrospectively analyzed for patients with nonvalvular atrial fibrillation who successfully underwent LAAC using the LAmbre device at the First Affiliated Hospital of Wenzhou Medical University between October 2018 and May 2022. The primary composite endpoint was thromboembolic (TE) events and device-related thrombus (DRT). RESULTS In total, 259 patients were evaluated using transesophageal echocardiography (TEE) at median intervals of 52 days (short term) and 385 days (long term). Patients were divided into a PR-covered group (n = 109) and a PR-uncovered group (n = 150). PR-uncovered patients showed a trend toward higher DRT incidence (8 of 150 vs 1 of 109, P = 0.056, log-rank test). The primary composite endpoint of TE events and DRT was significantly lower in the PR-covered group (14.0% vs 6.4%, P = 0.046, log-rank test). Any peridevice leak (PDL) was more frequent in the PR-covered group during both short-term (45.9% vs 28.7%, P = 0.004) and long-term (49.5% vs 25.3%, P < 0.001) follow-up, but no differences were observed for significant PDLs (> 3 mm). PR coverage was identified as an independent predictor of any long-term PDL (odds ratio 3.19, 95% confidence interval 1.64-6.18, P < 0.001). CONCLUSIONS PR coverage during LAAC with the LAmbre device was associated with a reduced risk of the primary composite endpoint of TE events and DRT, albeit with an increased incidence of nonsignificant PDL (≤ 3 mm).
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Affiliation(s)
- Jiaxu Shen
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China
| | - Yanyan Chen
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China
| | - Liangguo Wang
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China
| | - Shengjie Wu
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China
| | - Hao Zhou
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China
| | - Zhouqing Huang
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China
| | - Yihe Chen
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China
| | - Xiangxiang Shi
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China
| | - Xiao Chen
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China
| | - Xinlei Wu
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China
| | - Jincheng Xing
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China
| | - Zixuan Wang
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China
| | - Fangyi Xiao
- Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, PR China.
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Mezger M, Paitazoglou C, Frerker C, Stiermaier T, Eitel I. Steerable Delivery Sheath for Optimized LAA Closure: First Experience and Procedural Outcomes. Catheter Cardiovasc Interv 2024. [PMID: 39737660 DOI: 10.1002/ccd.31390] [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: 07/03/2024] [Revised: 12/15/2024] [Accepted: 12/20/2024] [Indexed: 01/01/2025]
Abstract
BACKGROUND The new Amplatzer Steerable Delivery Sheath is a delivery system designed to improve ease-of-use and procedural results of left atrial appendage closure (LAAC). We aimed to compare procedural results after switching our LAAC program at a tertiary care center with the Amulet device to the Steerable Delivery Sheath, with a control group of LAAC employing the standard sheath. METHODS The first n = 32 consecutively treated patients at our site using the Amulet device with the Steerable Delivery Sheath were included in this retrospective analysis. As a control-group, n = 39 consecutive patients treated with the Amulet device before the switch to the new sheath were used. RESULTS LAAC was successful in all patients in both groups (100%). Contrast use and fluoroscopy time were numerically higher in the steerable sheath group (steerable sheath vs. control group: contrast use 70 ± 23 vs. 55 ± 50 mL, p = 0.09, fluoroscopy time 12.7 ± 4.6 vs. 10.2 ± 6.6 min, p = 0.3). Fluoroscopy time and dose decreased after 3 months while contrast use remained unchanged. Complete sealing rate was high in both groups (steerable sheath vs. control group 97% vs. 95%, p > 0.9) and periprocedural complication rate was low, without any periprocedural stroke, vascular complications, or death in both cohorts. CONCLUSIONS LAAC with the Amplatzer Amulet steerable delivery sheath is feasible and safe. Fluoroscopy time and dose suggest a learning curve with the new sheath.
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Affiliation(s)
- Matthias Mezger
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christina Paitazoglou
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christian Frerker
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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Potpara T, Grygier M, Haeusler KG, Nielsen-Kudsk JE, Berti S, Genovesi S, Marijon E, Boveda S, Tzikas A, Boriani G, Boersma LVA, Tondo C, Potter TD, Lip GYH, Schnabel RB, Bauersachs R, Senzolo M, Basile C, Bianchi S, Osmancik P, Schmidt B, Landmesser U, Doehner W, Hindricks G, Kovac J, Camm AJ. An International Consensus Practical Guide on Left Atrial Appendage Closure for the Non-implanting Physician: Executive Summary. Thromb Haemost 2024. [PMID: 39657795 DOI: 10.1055/a-2469-4896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2024]
Abstract
Many patients with atrial fibrillation (AF) who are in need of stroke prevention are not treated with oral anticoagulation or discontinue treatment shortly after its initiation. Despite the availability of direct oral anticoagulants (DOACs), such undertreatment has improved somewhat but is still evident. This is due to continued risks of bleeding events or ischemic strokes while on DOAC, poor treatment compliance, or aversion to anticoagulant therapy. Because of significant improvements in procedural safety over the years left atrial appendage closure (LAAC), using a catheter-based, device implantation approach, is increasingly favored for the prevention of thromboembolic events in AF patients who cannot have long-term oral anticoagulation. This article is an executive summary of a practical guide recently published by an international expert consensus group, which introduces the LAAC devices and briefly explains the implantation technique. The indications and device follow-up are more comprehensively described. This practical guide, aligned with published guideline/guidance, is aimed at those non-implanting physicians who may need to refer patients for consideration of LAAC.
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Affiliation(s)
- Tatjana Potpara
- Medical Faculty, University of Belgrade, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University School of Medical Sciences, Poznan, Poland
| | - Karl Georg Haeusler
- Department of Neurology, Universitätsklinikum Würzburg (UKW), Würzburg, Germany
| | | | - Sergio Berti
- Ospedale del Cuore, Fondazione CNR Regione Toscana G. Monasterio, Pisa, Italy
| | - Simonetta Genovesi
- School of Medicine and Surgery, Nephrology Clinic, Monza, Italy and Istituto Auxologico Italiano, University of Milano-Bicocca, IRCCS, Milan, Italy
| | - Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Serge Boveda
- Cardiology, Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Brussels University VUB, Brussels, Belgium
| | - Apostolos Tzikas
- European Interbalkan Medical Centre, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Thessaloniki, Greece
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Lucas V A Boersma
- Cardiology Department, St. Antonius Hospital Nieuwegein/Amsterdam University Medical Centers, The Netherlands
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Department of Biomedical, Surgical and Dental Sciences, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy
| | - Tom De Potter
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Renate B Schnabel
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Rupert Bauersachs
- Cardioangiology Center Bethanien CCB, Frankfurt, Germany; Center for Vascular Research, Munich, Germany
| | - Marco Senzolo
- Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy
| | - Carlo Basile
- Division of Nephrology, EuDial Working Group of the European Renal Association, Miull General Hospital, Acquaviva delle Fonti, Italy
| | - Stefano Bianchi
- Nephrology and Dialysis Unit, Italian Society of Nephrology, ASL Toscana NordOvest, Livorno, Italy
| | - Pavel Osmancik
- Department of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum Charité, Charité University Medicine Berlin, Friede Springer Cardiovascular Prevention Center @Charité, Berlin, Germany
| | - Wolfram Doehner
- Berlin Institute of Health-Center for Regenerative Therapies, Berlin, Germany, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK)- Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jan Kovac
- Leicester NIHR BRU, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - A John Camm
- St. George's University of London, London, United Kingdom
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7
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Rienstra M, Tzeis S, Bunting KV, Caso V, Crijns HJGM, De Potter TJR, Sanders P, Svennberg E, Casado-Arroyo R, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Schnabel RB, Suwalski P, Tamargo J, Tica O, Traykov V, Kotecha D, Van Gelder IC. Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects. Europace 2024; 26:euae298. [PMID: 39716733 PMCID: PMC11666470 DOI: 10.1093/europace/euae298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 11/22/2024] [Indexed: 12/25/2024] Open
Abstract
Atrial fibrillation (AF) remains the most common cardiac arrhythmia worldwide and is associated with significant morbidity and mortality. The European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) have recently released the 2024 guidelines for the management of AF. This review highlights 10 novel aspects of the ESC/EACTS 2024 Guidelines. The AF-CARE framework is introduced, a structural approach that aims to improve patient care and outcomes, comprising of four pillars: [C] Comorbidity and risk factor management, [A] Avoid stroke and thromboembolism, [R] Reduce symptoms by rate and rhythm control, and [E] Evaluation and dynamic reassessment. Additionally, graphical patient pathways are provided to enhance clinical application. A significant shift is the new emphasis on comorbidity and risk factor control to reduce AF recurrence and progression. Individualized assessment of risk is suggested to guide the initiation of oral anticoagulation to prevent thromboembolism. New guidance is provided for anticoagulation in patients with trigger-induced and device-detected sub-clinical AF, ischaemic stroke despite anticoagulation, and the indications for percutaneous/surgical left atrial appendage exclusion. AF ablation is a first-line rhythm control option for suitable patients with paroxysmal AF, and in specific patients, rhythm control can improve prognosis. The AF duration threshold for early cardioversion was reduced from 48 to 24 h, and a wait-and-see approach for spontaneous conversion is advised to promote patient safety. Lastly, strong emphasis is given to optimize the implementation of AF guidelines in daily practice using a patient-centred, multidisciplinary and shared-care approach, with the simultaneous launch of a patient version of the guideline.
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Affiliation(s)
- Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | | | - Karina V Bunting
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Valeria Caso
- Stroke Unit, Santa Maria della Misericordia-University of Perugia, Perugia, Italy
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Emma Svennberg
- Department of Medicine Karolinska University Hospital (MedH), Karolinska Institutet, Stockholm, Sweden
| | - Ruben Casado-Arroyo
- Department of Cardiology, H.U.B.-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Luigina Guasti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Division of Geriatrics and Clinical Gerontology, ASST-Settelaghi, Varese, Italy
| | - Thorsten Hanke
- Clinic For Cardiac Surgery, Asklepios Klinikum, Harburg, Hamburg, Germany
| | - Tiny Jaarsma
- Department of Cardiology, Linkoping University, Linkoping, Sweden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maddalena Lettino
- Department for Cardiac, Thoracic and Vascular Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maja-Lisa Løchen
- Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - R Thomas Lumbers
- Institute of Health Informatics, University College London, London, UK
- Saint Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- University College Hospital, University College London Hospitals NHS Trust, London, UK
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | | | - Giuseppe M C Rosano
- Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, Rome, Italy
- Department of Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
- Cardiovascular Academic Group, St George’s University Medical School, London, UK
| | - Renate B Schnabel
- Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Piotr Suwalski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Juan Tamargo
- Pharmacology and Toxicology School of Medicine, Universidad Complutense, Madrid, Spain
| | - Otilia Tica
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, Emergency County Clinical Hospital of Bihor, Oradea, Romania
| | - Vassil Traykov
- Department of Invasive Electrophysiology, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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8
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Makkar A, Alkhouli M, Ellis CR, Shah AP, Coylewright M, Freeman JV, Anderson JA, Gage R, Lakkireddy D. Feasibility of Amulet occluder implantation after failed left atrial appendage occlusion attempt: Insights from the EMERGE LAA postapproval study. Heart Rhythm 2024; 21:2126-2135. [PMID: 38768843 DOI: 10.1016/j.hrthm.2024.05.004] [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: 03/22/2024] [Revised: 04/27/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Although expertise in left atrial appendage occlusion (LAAO) has grown, certain intricate anatomies may pose challenges, rendering them unsuitable for LAAO with the selected device. OBJECTIVE This analysis aimed to characterize outcomes of patients with prior failed percutaneous LAAO procedures who underwent a subsequent attempt with an Amulet occluder in the EMERGE LAA postapproval study. METHODS Patients enrolled in the National Cardiovascular Data Registry LAAO Registry who had an Amulet occluder implantation attempt between Food and Drug Administration approval (August 14, 2021) and June 30, 2023, were evaluated. A safety end point through 7 days or hospital discharge (whichever was later) and major adverse events through 45 days were reported. RESULTS A total of 8591 patients underwent attempted Amulet occluder implantation, of whom 244 patients had prior failed LAAO. Implantation success was 88.9% and 96.2% in patients with prior failed LAAO and index LAAO, respectively (P < .001). The safety composite end point was low, occurring in 1.6% and 0.8% of patients with prior failed LAAO and index LAAO, respectively (P = .148). Any major adverse event through 45 days occurred in 7.4% and 6.3% of prior failed LAAO and index LAAO patient cohorts, respectively (P = .497); most adverse events were similar between the groups (P > .05). At 45 days, peridevice leak ≤3 mm was achieved in >90% of patients in either group. CONCLUSION A high degree of implantation success with a low rate of adverse events can be achieved with the Amulet occluder. The findings imply that the dual occlusive mechanism Amulet occluder facilitates successful closure, even in challenging anatomic scenarios.
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Affiliation(s)
- Akash Makkar
- Arizona Heart Arrhythmia Associates, Phoenix, Arizona.
| | | | | | | | - Megan Coylewright
- Erlanger and University of Tennessee Health Science Center, College of Medicine, Chattanooga, Tennessee
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Ryan Gage
- Abbott Structural Heart, Plymouth, Minnesota
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Raja F, Rani K, Kumar S, Someshwar F, Naseer Khan MA, Abubakar F, Bhatt D, Subedi DJ, Shadmani S, Zahra Abdullah FT. Comparative Profiles of the WATCHMAN™ and Amplatzer™ Cardiac Plug/Amplatzer™ Amulet™ Devices for Left Atrial Appendage Closure in Non-valvular Atrial Fibrillation: A Comprehensive Systematic Review and Meta-analysis. J Innov Card Rhythm Manag 2024; 15:5917-5929. [PMID: 38948665 PMCID: PMC11210678 DOI: 10.19102/icrm.2024.15061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/19/2024] [Indexed: 07/02/2024] Open
Abstract
Atrial fibrillation (AF) is a prevalent cardiac arrhythmia marked by irregular and frequent tachycardic rhythms in the atria, affecting 1%-2% of the general population. The WATCHMAN™ device from Boston Scientific (Marlborough, MA, USA) and the Amplatzer™ Amulet™ device from Abbott (Chicago, IL, USA) are two devices used globally for left atrial appendage closure (LAAC) in non-valvular AF. A systematic search was conducted in PubMed, the Cochrane Library, and Elsevier's ScienceDirect literature databases to identify studies comparing the WATCHMAN™ procedure with Amulet™ device implantation for LAAC in patients with AF. The analyses were conducted using the random-effects model. A total of 20 studies were identified, with 18 falling into the category of observational studies and 2 being randomized controlled trials. A total of 6310 participants were included in this meta-analysis, with 3198 individuals (50.68%) assigned to the WATCHMAN™ procedure group and 3112 individuals (49.32%) allocated to the Amplatzer™ Cardiac Plug (ACP) group. The analysis revealed a higher risk of stroke associated with the WATCHMAN™ technique (relative risk [RR], 1.14), albeit without statistical significance. Conversely, the WATCHMAN™ approach led to a significantly lower risk of cardiac death (RR, 0.44; P = .04). Notably, the risks of all-cause mortality (RR, 0.89; 95% confidence interval [CI], 0.73-1.08; I 2 = 0%; P = .25) and major bleeding (RR, 0.93; 95% CI, 0.65-1.33; I 2 = 31%; P = .70) were clinically reduced with the WATCHMAN™ procedure, although statistical significance was not achieved. Compared to Amulet™ device implantation, WATCHMAN™ device implantation decreased the risk of cardiac mortality, while the risks of stroke, systemic embolism, all-cause mortality, and major bleeding were not statistically significant.
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Affiliation(s)
- Fnu Raja
- Department of Internal Medicine, Federal Medical and Dental College, Islamabad, Pakistan
| | - Khimya Rani
- Department of Internal Medicine, Chandka Medical College SMBBMU, Larkana, Pakistan
| | - Sunny Kumar
- Department of Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Fnu Someshwar
- Department of Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | - Fnu Abubakar
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Dhvani Bhatt
- Department of Internal Medicine, American University of Barbados, Bridgetown, Barbados
| | - Deepak Jung Subedi
- Department of Internal Medicine, College of Medical Sciences, Bharatpur, Nepal
| | - Sujeet Shadmani
- Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
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Potpara T, Grygier M, Häusler KG, Nielsen-Kudsk JE, Berti S, Genovesi S, Marijon E, Boveda S, Tzikas A, Boriani G, Boersma LVA, Tondo C, De Potter T, Lip GYH, Schnabel RB, Bauersachs R, Senzolo M, Basile C, Bianchi S, Osmancik P, Schmidt B, Landmesser U, Doehner W, Hindricks G, Kovac J, Camm AJ. Practical guide on left atrial appendage closure for the non-implanting physician: an international consensus paper. Europace 2024; 26:euae035. [PMID: 38291925 PMCID: PMC11009149 DOI: 10.1093/europace/euae035] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
A significant proportion of patients who suffer from atrial fibrillation (AF) and are in need of thromboembolic protection are not treated with oral anticoagulation or discontinue this treatment shortly after its initiation. This undertreatment has not improved sufficiently despite the availability of direct oral anticoagulants which are associated with less major bleeding than vitamin K antagonists. Multiple reasons account for this, including bleeding events or ischaemic strokes whilst on anticoagulation, a serious risk of bleeding events, poor treatment compliance despite best educational attempts, or aversion to drug therapy. An alternative interventional therapy, which is not associated with long-term bleeding and is as effective as vitamin K anticoagulation, was introduced over 20 years ago. Because of significant improvements in procedural safety over the years, left atrial appendage closure, predominantly achieved using a catheter-based, device implantation approach, is increasingly favoured for the prevention of thromboembolic events in patients who cannot achieve effective anticoagulation. This management strategy is well known to the interventional cardiologist/electrophysiologist but is not more widely appreciated within cardiology or internal medicine. This article introduces the devices and briefly explains the implantation technique. The indications and device follow-up are more comprehensively described. Almost all physicians who care for adult patients will have many with AF. This practical guide, written within guideline/guidance boundaries, is aimed at those non-implanting physicians who may need to refer patients for consideration of this new therapy, which is becoming increasingly popular.
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Affiliation(s)
- Tatjana Potpara
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- University Clinical Centre of Serbia, Belgrade, Serbia
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University School of Medical Sciences, Poznan, Poland
| | - Karl Georg Häusler
- Department of Neurology, Universitätsklinikum Würzburg (UKW), Würzburg, Germany
| | | | - Sergio Berti
- Ospedale del Cuore, Fondazione CNR Regione Toscana G. Monasterio, Pisa, Italy
| | - Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, Nephrology Clinic, Monza, Italy
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Serge Boveda
- Cardiology, Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Cardiologie Clinique Pasteur, Brussels University VUB, Brussels, Belgium
| | - Apostolos Tzikas
- Ippokrateio Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Structural and Congenital Heart Disease, European Interbalkan Medical Centre, Thessaloniki, Greece
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Lucas V A Boersma
- Cardiology Department, St. Antonius Hospital Nieuwegein/Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Claudio Tondo
- Centro Cardiologico Monzino, IRCCS, Department of Clinical Electrophysiology & Cardiac Pacing, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Tom De Potter
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Renate B Schnabel
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Rupert Bauersachs
- Cardioangiology Center Bethanien CCB, Frankfurt, Germany
- Center for Vascular Research, Munich, Germany
| | - Marco Senzolo
- Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy
| | - Carlo Basile
- Division of Nephrology, Miull General Hospital, Acquaviva delle Fonti, Italy
- EuDial Working Group of the European Renal Association, Acquaviva delle Fonti, Italy
| | - Stefano Bianchi
- Nephrology and Dialysis Unit, ASL Toscana NordOvest, Livorno, Italy
| | - Pavel Osmancik
- Department of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum Charité, Charité University Medicine, Berlin
| | - Wolfram Doehner
- Berlin Institute of Health-Center for Regenerative Therapies, Berlin, Germany
- Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK)- partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Jan Kovac
- Leicester NIHR BRU, University of Leicester, Glenfield Hospital, Leicester, UK
| | - A John Camm
- Genetic and Cardiovascular Sciences Institute, Cardiology Academic Group, St. George’s University of London, Cranmer Terrace, London SW190RE, UK
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