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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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Mitsis A, Eftychiou C, Samaras A, Tzikas A, Fragakis N, Kassimis G. Left atrial appendage occlusion in atrial fibrillation: shaping the future of stroke prevention. Future Cardiol 2025; 21:391-404. [PMID: 40136040 PMCID: PMC12026124 DOI: 10.1080/14796678.2025.2484964] [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] [Received: 10/24/2024] [Accepted: 03/24/2025] [Indexed: 03/27/2025] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, significantly increasing the risk of thromboembolic events, particularly ischemic stroke. The left atrial appendage (LAA) is the predominant site of thrombus formation in patients with AF, making it a crucial target for stroke prevention strategies. Left atrial appendage occlusion (LAAO) has emerged as an important therapeutic alternative to oral anticoagulation, particularly in patients with contraindications to long-term anticoagulant therapy. This review examines the role of LAAO in AF management, discussing current indications, patient selection, procedural techniques, and clinical outcomes. We also explore the latest evidence from major clinical trials and real-world studies, highlighting the efficacy and safety of LAAO compared to standard anticoagulation. Additionally, we consider the unresolved questions and the potential future directions for this intervention, including emerging technologies and the integration of LAAO into broader AF management protocols. Our review underscores the growing importance of LAAO in reducing thromboembolic risk in AF patients, particularly those unable to tolerate traditional anticoagulation, and offers insights into the ongoing evolution of this treatment modality in clinical practice.
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Affiliation(s)
- Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, State Health Services Organization, Nicosia, Cyprus
| | - Christos Eftychiou
- Cardiology Department, Nicosia General Hospital, State Health Services Organization, Nicosia, Cyprus
| | - Athanasios Samaras
- Second Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Tzikas
- Second Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Cardiology, European Interbalkan Medical Center, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Kassimis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Zhang Z, Fu X, Guo M, Gao J, Wang R. Left atrial appendage occlusion and radiofrequency ablation in a patient with atrial fibrillation and dextrocardia: a case report. Front Cardiovasc Med 2025; 11:1525387. [PMID: 39882313 PMCID: PMC11776092 DOI: 10.3389/fcvm.2024.1525387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 12/30/2024] [Indexed: 01/31/2025] Open
Abstract
Background Dextrocardia is a rare congenital condition, affecting approximately 1 in 10,000-12,000 individuals. When combined with atrial fibrillation (AF), it becomes even rarer. "One-stop" surgery, including combined radiofrequency ablation (RFA) and left atrial appendage occlusion (LAAO), has become a common clinical treatment for patients with AF who develop cerebral infarction despite regular oral anticoagulants. To date, no cases have been reported of patients with AF and dextrocardia undergoing the "one-stop" procedure, making this surgery particularly challenging. Case presentation An 85-year-old dextrocardia male with total visceral inversion and persistent AF developed cerebral infarction despite regular oral anticoagulation therapy. He was referred to our hospital for RFA of AF and LAAO. The procedure was successfully performed using a three-dimensional electroanatomical mapping system (Carto3, Biosense Webster, Diamond Bar, CA, USA), intracardiac echocardiography (ICE), and x-ray, with no complications. Conclusion This is the first reported case of a "one-stop" surgery for dextrocardia with AF. This procedure is safe and feasible with the assistance of advanced technologies such as ICE and the VIZIGO bidirectional adjustable bent sheath.
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Affiliation(s)
- Zengfu Zhang
- The First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiaohong Fu
- The First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Min Guo
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jia Gao
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Rui Wang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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4
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Mills MT, Gupta D. Left Atrial Appendage Occlusion in Patients Receiving Hemodialysis: A Viable Approach to Stroke Prevention? JACC. ASIA 2025; 5:187-190. [PMID: 39896247 PMCID: PMC11782096 DOI: 10.1016/j.jacasi.2024.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Affiliation(s)
- Mark T. Mills
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Cardiology, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Cardiology, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
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5
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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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Potpara T, Romiti GF, Sohns C. The 2024 European Society of Cardiology Guidelines for Diagnosis and Management of Atrial Fibrillation: A Viewpoint from a Practicing Clinician's Perspective. Thromb Haemost 2024; 124:1087-1094. [PMID: 39374908 DOI: 10.1055/a-2434-9244] [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: 10/09/2024]
Abstract
Atrial fibrillation (AF) is a complex disease requiring a multidomain and (usually) long-term management, thus posing a significant burden to patients with AF, practitioners, and health care system. Unlike cardiovascular conditions with a narrow referral pathway (e.g., acute coronary syndrome), AF may be first detected by a wide range of specialties (often noncardiology) or a general practitioner. Since timely initiated optimal management is essential for the prevention of AF-related complications, a concise and simple guidance is essential for practitioners managing AF patients, regardless of their specialty. Guideline-adherent management of patients with AF has been shown to translate to improved patient outcomes compared with guideline-nonadherent treatment. To facilitate guideline implementation in routine clinical practice, a good guideline document on AF should introduce only evidence-based new recommendations, while avoiding arbitrary changes, which may be confusing to practitioners. Herein, we discuss the main changes in the 2024 European Society of Cardiology (ESC) AF Guidelines relative to the previous 2020 ESC document. Whether the updates and new recommendations issued by the new guidelines will translate in high adherence in clinical practice (and hence improved prognosis of patients with AF) will need to be addressed in upcoming years.
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Affiliation(s)
- Tatjana Potpara
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Intensive Care for Arrhythmias, Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Giulio F Romiti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Christian Sohns
- Clinic for Electrophysiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, Med. Fakultät OWL (Universität Bielefeld), Bad Oeynhausen, Germany
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Karpierz JI, Piotrowski M, Bartuś K, Chmiel R, Wijatkowska K, Słomka A. Device-Assisted Left Atrial Appendage Exclusion: From Basic Sciences to Clinical Applications. J Cardiovasc Dev Dis 2024; 11:332. [PMID: 39452302 PMCID: PMC11508359 DOI: 10.3390/jcdd11100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 10/05/2024] [Accepted: 10/17/2024] [Indexed: 10/26/2024] Open
Abstract
Device-assisted left atrial appendage exclusion plays a crucial role in the prevention of fatal ischemic complications in patients with atrial fibrillation and contraindications to anticoagulation treatment. Various devices with different safety profiles and device-related complications are available in daily practice to perform this procedure. In this review, the anatomy, physiology, and functions of the left atrial appendage were detailed, and all available devices used for epicardial and endocardial exclusion of the left atrial appendage and their clinical outcomes were discussed. Future research should aim to further investigate the long-term effects of left atrial appendage exclusion on body homeostasis, blood coagulation, and cardiac function.
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Affiliation(s)
- Julia Izabela Karpierz
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (J.I.K.)
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Michał Piotrowski
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (J.I.K.)
| | - Krzysztof Bartuś
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (J.I.K.)
| | - Radosław Chmiel
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Katarzyna Wijatkowska
- Department of Cardiac Anesthesiology, Regional Specialist Hospital, 86-300 Grudziądz, Poland
| | - Artur Słomka
- Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland;
- National Medical Institute of the Ministry of the Interior and Administration, 137 Wołoska Street, 02-507 Warsaw, Poland
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8
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Mills MT, Kirmani BH, Lip GYH. Left Atrial Appendage Occlusion in Patients Without Atrial Fibrillation Undergoing Cardiac Surgery: The Evidence Is Mounting. Circ Cardiovasc Interv 2024; 17:e014633. [PMID: 39258361 DOI: 10.1161/circinterventions.124.014633] [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: 09/12/2024]
Affiliation(s)
- Mark T Mills
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, United Kingdom (M.T.M., B.H.K., G.Y.H.L.)
- Department of Cardiology (M.T.M., G.Y.H.L.), Liverpool Heart and Chest Hospital NHS Foundation Trust, United Kingdom
| | - Bilal H Kirmani
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, United Kingdom (M.T.M., B.H.K., G.Y.H.L.)
- Department of Cardiothoracic Surgery (B.H.K.), Liverpool Heart and Chest Hospital NHS Foundation Trust, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, United Kingdom (M.T.M., B.H.K., G.Y.H.L.)
- Department of Cardiology (M.T.M., G.Y.H.L.), Liverpool Heart and Chest Hospital NHS Foundation Trust, United Kingdom
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Denmark (G.Y.H.L.)
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Genovesi S, Camm AJ, Covic A, Burlacu A, Meijers B, Franssen C, Luyckx V, Liakopoulos V, Alfano G, Combe C, Basile C. Treatment strategies of the thromboembolic risk in kidney failure patients with atrial fibrillation. Nephrol Dial Transplant 2024; 39:1248-1257. [PMID: 38816212 PMCID: PMC11288792 DOI: 10.1093/ndt/gfae121] [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] [Received: 02/17/2024] [Indexed: 06/01/2024] Open
Abstract
The incidence and prevalence of atrial fibrillation (AF) in patients affected by kidney failure, i.e. glomerular filtration rate <15 ml/min/1.73 m2, is high and probably underestimated. Numerous uncertainties remain regarding how to prevent thromboembolic events in this population because both cardiology and nephrology guidelines do not provide clear recommendations. The efficacy and safety of oral anticoagulant therapy (OAC) in preventing thromboembolism in patients with kidney failure and AF has not been demonstrated for either vitamin K antagonists (VKAs) or direct anticoagulants (DOACs). Moreover, it remains unclear which is more effective and safer, because estimated creatinine clearance <25-30 ml/min was an exclusion criterion in the randomized controlled trials (RCTs). Three RCTs comparing DOACs and VKAs in kidney failure failed to reach the primary endpoint, as they were underpowered. The left atrial appendage is the main source of thromboembolism in the presence of AF. Left atrial appendage closure (LAAC) has recently been proposed as an alternative to OAC. RCTs comparing the efficacy and safety of LAAC versus OAC in kidney failure were terminated prematurely due to recruitment failure. A recent prospective study showed a reduction in thromboembolic events in haemodialysis patients with AF and undergoing LAAC compared with patients taking or not taking OAC. We review current treatment standards and discuss recent developments in managing the thromboembolic risk in kidney failure patients with AF. The importance of shared decision-making with the multidisciplinary team and the patient to consider individual risks and benefits of each treatment option is underlined.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, Nephrology Clinic, Monza, Italy
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - A John Camm
- St. George's University of London, London, UK
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center – ‘C.I. Parhon’ University Hospital and 'Grigore T. Popa’ University of Medicine, Iasi, Romania
| | - Alexandru Burlacu
- Nephrology Clinic, Dialysis and Renal Transplant Center – ‘C.I. Parhon’ University Hospital and 'Grigore T. Popa’ University of Medicine, Iasi, Romania
| | - Björn Meijers
- Nephrology Unit, University Hospitals Leuven and Department of Microbiology, Immunology and Organ Transplantation, KU Leuven, Leuven, Belgium
| | - Casper Franssen
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Valerie Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Vassilios Liakopoulos
- Second Department of Nephrology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gaetano Alfano
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - Christian Combe
- Department of Nephrology, CHU de Bordeaux and INSERM U1026, University of Bordeaux, Bordeaux, France
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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10
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Aarnink EW, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Protopopov AV, Betts T, Mazzone P, Grygier M, Sievert H, De Potter T, Vireca E, Stein K, Bergmann MW, Boersma LVA. Incidence and predictors of 2-year mortality following percutaneous left atrial appendage occlusion in the EWOLUTION trial. Europace 2024; 26:euae188. [PMID: 39082730 PMCID: PMC11289730 DOI: 10.1093/europace/euae188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/15/2024] [Indexed: 08/03/2024] Open
Abstract
AIMS Sufficient survival time following left atrial appendage occlusion (LAAO) is essential for ensuring the efficacy and cost-effectiveness of this strategy for stroke prevention. Understanding prognostic factors for early mortality after LAAO could optimize patient selection. In the current study, we perform an in-depth analysis of 2-year mortality after LAAO, focusing particularly on potential predictors. METHODS AND RESULTS The EWOLUTION registry is a real-world cohort comprising 1020 patients that underwent LAAO. Endpoint definitions were pre-specified, and death was categorized as cardiovascular, non-cardiovascular, or unknown origin. Mortality rates were calculated from Kaplan-Meier estimates. Baseline characteristics significantly associated with death in univariate Cox regression analysis were incorporated into the multivariate analysis. All multivariate predictors were included in a risk model. Two-year mortality rate was 16.4% [confidence interval (CI): 14.0-18.7%], with 50% of patients dying from a non-cardiovascular cause. Multivariate baseline predictors of 2-year mortality included age [hazard ratio (HR) 1.05, CI: 1.03-1.08, per year increase], heart failure (HR 1.73, CI: 1.24-2.41), vascular disease (HR 1.47, CI: 1.05-2.05), valvular disease (HR 1.63, CI: 1.15-2.33), abnormal liver function (HR 1.80, CI: 1.02-3.17), and abnormal renal function (HR 1.58, CI: 1.10-2.27). Mortality rate exhibited a gradual rise as the number of risk factors increased, reaching 46.1% in patients presenting with five or six risk factors. CONCLUSION One in six patients died within 2 years after LAAO. We identified six independent predictors of mortality. When combined, this model showed a gradual increase in mortality rate with a growing number of risk factors, which may guide appropriate patient selection for LAAO. CLINICAL TRIAL REGISTRATION The original EWOLUTION registry was registered at clinicaltrials.gov under identifier NCT01972282.
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Affiliation(s)
- Errol W Aarnink
- Department of Cardiology, St Antonius Ziekenhuis Nieuwegein/AUMC Amsterdam, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Hueseyin Ince
- Department of Cardiology, Vivantes Klinikum Am Urban and Neukölln, Berlin, Germany
- Department of Cardiology, Universitätsmedizin Rostock, Rostock, Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Thomas Schmitz
- Department of Cardiology, Elisabeth Krankenhaus Essen, Essen, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt/Main, Germany
| | - Tommaso Gori
- Department of Cardiology, Universitätsmedizin Mainz und DZHK Standort Rhein-Main, Mainz, Germany
| | - Felix Meincke
- Department of Cardiology, Asklepios Klinik Altona, Hamburg, Germany
| | | | - Timothy Betts
- Department of Cardiology, Oxford University Hospitals NHS Trust, UK
| | - Patrizio Mazzone
- Arrhythmology and Cardiac Pacing Unit, San Raffaele University-Hospital, Milan, Italy
| | - Marek Grygier
- Chair and 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Tom De Potter
- Department of Cardiology, Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium
| | | | | | - Martin W Bergmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Klinik Altona, Hamburg, Germany
| | - Lucas V A Boersma
- Department of Cardiology, St Antonius Ziekenhuis Nieuwegein/AUMC Amsterdam, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
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Beney J, Galea R, Siontis G, Gräni C, Kueffer T, Brugger N, Reichlin T, Räber L, Roten L. Feasibility study on atrial fibrillation ablation with pulsed field ablation and concomitant occlusion of the left atrial appendage. Europace 2024; 26:euae176. [PMID: 38917059 PMCID: PMC11242437 DOI: 10.1093/europace/euae176] [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] [Received: 05/30/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
AIMS Atrial fibrillation (AF) ablation and left atrial appendage occlusion (LAAO) are increasingly performed as individual procedures. Pulsed field ablation (PFA) has significantly reduced procedure duration and may be advantageous for the combined approach. METHODS AND RESULTS We have launched a programme for simultaneous AF ablation using PFA and LAAO for patients qualifying for both treatments and excluding those with a complex anatomy. We compare procedure duration and fluoroscopy time against individual procedures (either AF ablation or LAAO alone), all performed by the same operators and using consistent technologies. We performed the combined procedure in 10 patients (50% males; median age 70 years) and excluded 2 patients (17%) because of a complex left atrial appendage anatomy. No death, stroke, or major bleeding events, including pericardial effusion, occurred. For single-procedure comparison, 207 AF ablation procedures and 61 LAAO procedures were available. The total median procedure duration was 79 min (range 60-125) for the combined procedure, 71 min (25-241) for individual AF ablation (51 min without and 78 min with 3-dimensional electroanatomic mapping), and 47 min (15-162) for individual LAAO. The respective fluoroscopy times were 21 (15-26), 15 (5-44), and 10 (3-50) min. For the combined procedure, femoral vein access to last PFA application lasted 49 min (34-93) and LAAO added 20 min (15-37). CONCLUSION Simultaneous PFA-based AF ablation and LAAO in carefully selected patients is feasible and safe and can be executed within a short overall procedure duration.
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Affiliation(s)
- Jennifer Beney
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Georgios Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
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12
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Genovesi S, Bianchi S, Basile C. Role of the left atrial appendage closure in preventing thromboembolism in atrial fibrillation: what is the importance for chronic kidney disease patients? J Nephrol 2024; 37:1197-1200. [PMID: 38656567 DOI: 10.1007/s40620-024-01944-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/24/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, Nephrology Clinic, Via Cadore 48, 20900, Monza, Italy.
- Istituto Auxologico Italiano, IRCCS, Milan, Italy.
| | - Stefano Bianchi
- Nephrology and Dialysis Unit, ASLToscana NordOvest, Leghorn, Italy
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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13
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Maksym J, Scisło P, Kapłon-Cieślicka A, Huczek Z, Marchel M, Kochman J, Zbroński K, Opolski G, Grabowski M, Mazurek T. Incidence and predictors of device-related thrombus after left atrial appendage closure with Watchman device. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2024; 20:164-171. [PMID: 39022721 PMCID: PMC11249867 DOI: 10.5114/aic.2024.140315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/28/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Left atrial appendage closure (LAAC) with Watchman device prevents thromboembolism in patients with atrial fibrillation (AF). However, thrombus may develop on the atrial surface of the device. Aim To investigate the incidence and predictors of device-related thrombus (DRT) in patients with AF who were treated with LAAC. Material and methods Ninety-one consecutive patients with AF underwent LAAC procedure using first-generation Watchman 2.5 device followed by antiplatelet therapy. In our analysis we have included all patients (n = 78) who had clinical follow-up visits with transesophageal echocardiography (TEE) after the procedure. Results The median (IQR) CHA2DS2-VASc score was 4 (4.0-6.0) and HAS-BLED score was 3 (3.0-4.0). DRTs were observed in 5 (6.4%) patients. When compared with patients without DRT, those with DRT presented more often with lower median ejection fraction (40% (23.5-45.5) versus 55% (48.0-60.0); p = 0.005), lower emptying velocity of LAA (25 cm/s (17.5-27.0) versus 53 cm/s (26.5-78.0); p = 0.009), and with greater depth of implantation (18 mm (14.0-20.5) versus 8 mm (5.0-11.0); p < 0.001). Furthermore, patients with DRT had greater depth of LAA (35 mm (29.5-41.0) versus 29 mm (25.5-31.0); p = 0.003), greater mean (SD) dimension in 900 (22.4 mm (3.2) versus 19 mm (2.7); p = 0.02). Patients with DRT were also younger than those without DRT (67.4 years (7) versus 75 years (8.3), p = 0.045). Conclusions The DRT after Watchman device implantation remains a rare complication. Its formation was related to several patient and procedural characteristics, which need to be confirmed in larger studies.
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Affiliation(s)
- Jakub Maksym
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Scisło
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Zenon Huczek
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Marchel
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Karol Zbroński
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Grabowski
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Mazurek
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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