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Ke JY, Jin LS, Lin YN, Xu J, Liu WK, Fu JY, Li L, Chen YL, Qiu YX, Li YC. Combined atrial fibrillation ablation and left atrial appendage closure: Watchman vs. LAmbre devices. Front Cardiovasc Med 2022; 9:1011037. [PMID: 36407450 PMCID: PMC9666484 DOI: 10.3389/fcvm.2022.1011037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/17/2022] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Left atrial appendage closure (LAAC) combined with radiofrequency catheter ablation is an emerging one-stop hybrid procedure for non-valvular atrial fibrillation (AF). This study was performed to compare the efficacy and safety of the Watchman device vs. the LAmbre device for this combined procedure. METHODS Two hundred and thirty two patients with AF who underwent the combined procedure were enrolled and divided into two subgroups depending on the device choice: the Watchman-combined group (n = 118) and the LAmbre-combined group (n = 114). The periprocedural and follow-up adverse events in both groups were documented. RESULTS The mean CHA2DS2-VASc score and HAS-BLED score in the Watchman-combined group and LAmbre-combined group were 3.7 ± 1.5 vs. 3.8 ± 1.5 and 2.5 ± 1.1 vs. 2.3 ± 1.1, respectively (all P > 0.05). Successful LAAC was achieved in all patients. The rate of major periprocedural complications and AF recurrence at 6 months post-procedure were similar between the Watchman-combined group and LAmbre-combined group (0.8 vs. 0.9%, P = 1.00; 22.0 vs. 15.8%, P = 0.23). During 2.6 ±0 .7 vs.1.6 ± 1.6 years follow-up, the rate of major clinical adverse events, including stroke and major bleeding, were comparable between the Watchman-combined group and the LAmbre-combined group (2.6 vs. 1.1% per 100 patient-years, P = 0.33). The intraprocedural peri-device leakage (PDL) rate was similar between the Watchman-combined group and the LAmbre-combined group (5.1 vs. 6.1%, P = 0.73), but the PDL rate was significantly higher at 3-6 months transesophageal echocardiography (TEE) follow-up than the intraprocedural PDL rate in both groups (21.6 vs. 5.1%; 36.6 vs. 6.1%, respectively), with a more obvious increase in minimal PDL rate in the LAmbre-combined group than the Watchman-combined group (36.6 vs. 21.6%, P < 0.05). CONCLUSION The Watchman and LAmbre devices were comparable in efficacy and safety for the combined procedure. The minimal PDL rate at short-term TEE follow-up was higher in the LAmbre-combined group than the Watchman-combined group.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yue-Chun Li
- Department of Cardiology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Zhang HD, Yang M, Xing YB, Weng SX, Ding L, Ding XT, Hu LX, Qi YJ, Yu FY, Zhang JT, Fang PH, Hua W, Zhang S, Tang M. Occluding morphologically complicated left atrial appendage using the small-umbrella LAmbre device. BMC Cardiovasc Disord 2022; 22:326. [PMID: 35869446 PMCID: PMC9308203 DOI: 10.1186/s12872-022-02770-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/15/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Percutaneous left atrial appendage (LAA) occlusion is effective for stroke prevention in patients with atrial fibrillation. LAA can have a complex anatomy, such as multiple lobes or a large orifice, which may render it unsuitable for occlusion using regular devices. We aimed to investigate the feasibility, safety, and short-term efficacy of the small-umbrella LAmbre device for morphologically complicated LAA. METHODS We retrospectively enrolled 129 consecutive patients who underwent LAA occlusion using the LAmbre device; the small-umbrella LAmbre device was used in 30 of these patients. We analyzed patients' characteristics, procedural details, and outcomes. RESULTS Twenty-two patients (73.3%) had multilobed (≥ 2) LAA. The umbrella of the occluder was anchored in the branch in 9 patients and in the common trunks of branches in 13 patients. The landing zone and orifice diameters were 19.0 ± 4.39 mm and 27.4 ± 3.95 mm, respectively. The sizes of the umbrella and occluder cover were 22.0 ± 3.42 mm and 34.3 ± 2.75 mm, respectively. At 3-month follow-up transesophageal echocardiography in 24 patients, no peri-device residual flow was reported. Device thrombosis was detected in one patient at 3 months and disappeared after 3 months of anticoagulation. Ischemic stroke occurred in one patient; no other adverse events were reported. CONCLUSIONS Occlusion of morphologically complicated LAA using the small-umbrella LAmbre device was feasible, safe, and effective in patients with atrial fibrillation in this study. This occluder provides an alternative for patients who cannot be treated with regular-sized LAA occlusion devices.
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Affiliation(s)
- Hong-Da Zhang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Ming Yang
- Department of Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, 653100, Yunnan, China
| | - Yang-Bo Xing
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing, 312000, Zhejiang, China
| | - Si-Xian Weng
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Lei Ding
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xiao-Tong Ding
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Li-Xing Hu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Ying-Jie Qi
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Feng-Yuan Yu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jing-Tao Zhang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Pi-Hua Fang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Shu Zhang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Min Tang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
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Fang P, Wei Y, Wang J, Wang X, Yang H. Post-angiography Retention of the Contrast Agent in the Left Atrial Appendage Is Associated With Risk of Cardioembolic Stroke in Patients With Atrial Fibrillation: A Retrospective Study. Front Cardiovasc Med 2021; 8:753949. [PMID: 34778408 PMCID: PMC8581209 DOI: 10.3389/fcvm.2021.753949] [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: 08/05/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Atrial fibrillation (AF) represents an important risk factor for cardioembolic stroke, and most atrial thrombi originate from the left atrial appendage (LAA). Although the CHA2DS2-VASc score is widely used to estimate the risk of cardioembolic stroke in AF patients, yet greatly affected by many factors. This study was undertaken to determine the association between contrast agent retention in LAA after LAA angiography and risks of cardioembolic stroke in patients with AF. Methods: This is a retrospective study. The demographic and clinical data of AF patients undergone left atrial appendage occlusion (LAAO) with or without catheter radiofrequency ablation were retrospectively analyzed. The patients were classified into either stroke or non-stroke group by the history with cardioembolic stroke or transient ischemic attack (TIA). Results: Sixty-two consecutive patients undergone LAAO were finally included, in whom 31 AF patients had a history of cardioembolic stroke or TIA (one TIA), and significantly higher CHA2DS2-VASc score (4.2 ± 1.4 vs. 3.3 ± 1.3; P = 0.006) as well as incidence of contrast agent retention in LAA (n = 20 vs. n = 7; P = 0.001) compared to the patients in non-stroke group. In addition, the relative proportion of distinctive morphological types of LAA was significantly different between groups (P < 0.001). Multivariate logistic regression analysis showed that higher CHA2DS2-VASc scores (OR = 1.7, 95% CI: 1.0-3.0, P = 0.046) and LAA contrast agent retention (OR = 5.1, 95% CI: 1.1-23.9, P = 0.002) were associated with increased risks of cardioembolic stroke. The patients with Windsock type LAA (OR = 7.8, 95% CI: 1.1-57.2, P = 0.044) and Cauliflower LAA (OR = 20.2, 95% CI: 3.2-125.5, P = 0.001) were more prone to cardioembolic stroke compared to those with Chicken Wing type LAA. Conclusion: Left atrial appendage contrast agent retention after LAA angiography is associated with the risks of cardioembolic stroke in patients with AF, and cardioembolic stroke is more seen in AF patients with Windsock or Cauliflower type LAA.
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Affiliation(s)
- Ping Fang
- Department of Cardiology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
| | - Youquan Wei
- Department of Cardiology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
| | - Jinfeng Wang
- Department of Cardiology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
| | - Xianghai Wang
- Department of Cardiology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
| | - Hao Yang
- Department of Cardiology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
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Wang X, Chen X, Ye Y, Peng J, Lin J, Deng X, Lin L, You J, Wang X, Zhou D, Chen Q, Ge J. Troponin T Elevation After Percutaneous Left Atrial Appendage Occlusion. Front Cardiovasc Med 2021; 8:721224. [PMID: 34660722 PMCID: PMC8517138 DOI: 10.3389/fcvm.2021.721224] [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: 06/06/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Cardiac troponin T (cTNT) has been widely used in detecting cardiac damage. Elevated cTNT level has been reported to be associated with increased mortality in multiple cardiac conditions. It is not uncommon to observe an increased level of cTNT in patients after left atrial appendage occlusion (LAAO). The objective of the study is to study the incidence, significance, and factors associated with cTNT elevation after LAAO. Methods: We prospectively included patients who underwent LAAO from January 2019 to July 2020 in Fudan Zhongshan Hospital. Patients were divided into those with elevated cTNT after procedure and those with normal postprocedure cTNT. All individuals were followed up for 1 year. The primary outcome is major adverse cardiovascular events, which include myocardial infarction, heart failure, cardiac death, and stroke. The second outcome is periprocedure complication, including chest pain, tachycardia, cardiac tamponade, change of electrocardiograph, and atrial thrombus. Results: A total of 190 patients were enrolled. Of the patients, 85.3% had elevated cTNT after LAAO, while 14.7% of them did not. Exposure time, dosage of contrast, types of devices, shapes, and sizes of LAA could contribute to elevated postprocedure cTNT. We found that patients with a Watchman device were more likely to have elevated postprocedure cTNT than those with a Lambre device (89.2 vs. 76.7%, p = 0.029). LAAO shapes were associated with cTNT levels in patients with a Watchman device, while the diameter of the outer disc and LAA depth mattered for the Lambre device. There was no significant difference in the primary and second outcome between the two groups (p-value: 0.619, 0.674). Conclusion: LAAO was found to be commonly accompanied with cTNT elevation, which might not to be related to the complications and adverse cardiac outcomes within 1 year of follow-up. Moreover, eGFR at baseline, exposure time, dosage of contrast, types of LAAO device, and LAA morphology could contribute to cTNT elevation.
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Affiliation(s)
- Xiaoyan Wang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Institute of Biomedical Science, Fudan University, Shanghai, China
| | - Xueying Chen
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Institute of Biomedical Science, Fudan University, Shanghai, China
| | - Yong Ye
- Department of Cardiovascular Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Juan Peng
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Institute of Biomedical Science, Fudan University, Shanghai, China
| | - Jinyi Lin
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Institute of Biomedical Science, Fudan University, Shanghai, China
| | - Xin Deng
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Institute of Biomedical Science, Fudan University, Shanghai, China
| | - Li Lin
- Department of Cardiovascular Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jieyun You
- Department of Cardiovascular Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xingxu Wang
- Department of Cardiovascular Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Daxin Zhou
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Institute of Biomedical Science, Fudan University, Shanghai, China
| | - Qingxing Chen
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Institute of Biomedical Science, Fudan University, Shanghai, China
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Institute of Biomedical Science, Fudan University, Shanghai, China
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Comparison of Left Atrial Appendage Occlusion versus Non-Vitamin-K Antagonist Oral Anticoagulation in High-Risk Atrial Fibrillation: An Update. J Cardiovasc Dev Dis 2021; 8:jcdd8060069. [PMID: 34208117 PMCID: PMC8230807 DOI: 10.3390/jcdd8060069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/03/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Transcatheter left atrial appendage occlusion (LAAO) is non-inferior to vitamin K antagonists (VKAs) in preventing thromboembolic events in atrial fibrillation (AF). Non-vitamin K antagonists (NOACs) have an improved safety profile over VKAs; however, evidence regarding their effect on cardiovascular and neurological outcomes relative to LAAO is limited. Up-to-date randomized trials or propensity-score-matched data comparing LAAO vs. NOACs in high-risk patients with AF were pooled in our study. A total of 2849 AF patients (LAAO: 1368, NOACs: 1481, mean age: 75 ± 7.5 yrs, 63.5% male) were enrolled. The mean CHA2DS2-VASc score was 4.3 ± 1.7, and the mean HAS-BLED score was 3.4 ± 1.2. The baseline characteristics were comparable between the two groups. In the LAAO group, the success rate of device implantation was 98.8%. During a mean follow-up of 2 years, as compared with NOACs, LAAO was associated with a significant reduction of ISTH major bleeding (p = 0.0002). There were no significant differences in terms of ischemic stroke (p = 0.61), ischemic stroke/thromboembolism (p = 0.63), ISTH major and clinically relevant minor bleeding (p = 0.73), cardiovascular death (p = 0.63), and all-cause mortality (p = 0.71). There was a trend toward reduction of combined major cardiovascular and neurological endpoints in the LAAO group (OR: 0.84, 95% CI: 0.64-1.11, p = 0.12). In conclusion, for high-risk AF patients, LAAO is associated with a significant reduction of ISTH major bleeding without increased ischemic events, as compared to "contemporary NOACs". The present data show the superior role of LAAO over NOACs among high-risk AF patients in terms of reduction of major bleeding; however, more randomized controlled trials are warranted.
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Long-Term Safety and Efficacy of Percutaneous Left Atrial Appendage Closure with the LAmbre Device. J Interv Cardiol 2020; 2020:6613683. [PMID: 33424491 PMCID: PMC7769662 DOI: 10.1155/2020/6613683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/28/2020] [Accepted: 12/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Left atrial appendage closure (LAAC) using the LAmbre device has been associated with prevention of stroke in patients with nonvalvular atrial fibrillation (AF). Here, we interrogated the long-term safety and efficacy of using the LAmbre device in percutaneous LAAC. Methods We analyzed 56 records of patients with nonvalvular AF undergoing LAAC procedures with the LAmbre device. We collected and analyzed the data to define the safety and efficacy of the LAmbre device implantation. Result The LAAC was successfully occluded in the 56 patients. Our data showed no serious residual leak or pericardial effusion occurred during the perioperative period. At a mean follow-up of 37.8 ± 23.5 months, there were 7.1%, 3.6%, and 3.6% rates of death, stroke, and device-related thrombus, respectively. There were no cases of severe residual leak or systemic embolism. Conclusion Taken together, we demonstrate that execution of LAAC with the LAmbre device has high procedural success and prevents AF-related stroke. However, further large-scale trials might be required to confirm our findings.
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Li SY, Wang J, Hui X, Zhu HJ, Wang BY, Xu H. Meta-analysis of postoperative antithrombotic therapy after left atrial appendage occlusion. J Int Med Res 2020; 48:300060520966478. [PMID: 33249962 PMCID: PMC7708721 DOI: 10.1177/0300060520966478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective This meta-analysis explored the safety and effectiveness of different anticoagulant regimens after left atrial appendage occlusion (LAAO). Methods Databases, such as PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Library, were searched to identify eligible studies according to the inclusion criteria. The incidences of events, including device-related thrombus (DRT) formation, stroke, systemic thromboembolism, bleeding, cardiovascular mortality, and all-cause mortality, were analyzed using R version 3.2.3. Results The screening retrieved 32 studies, including 36 study groups and 4,474 patients. The incidence of outcomes after LAAO was calculated via meta-analysis. In the subgroup analysis, the rates of DRT formation, cardiovascular mortality, and all-cause mortality were significantly different among different antithrombotic methods. Single antiplatelet therapy was associated with the highest rate of adverse events, followed by dual antiplatelet therapy (DAPT). Vitamin K antagonists (VKAs) and new oral anticoagulants (NOACs) carried lower rates of adverse events. Conclusions Anticoagulant therapy had better safety and efficacy than antiplatelet therapy. Thus, for patients with nonabsolute anticoagulant contraindications, anticoagulant therapy rather than DAPT should be actively selected. NOACs displayed potential for further development, and these treatments might represent alternatives to VKAs in the future.
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Affiliation(s)
- Shu-Yue Li
- Department of Pharmacy, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Jiangsu Nanjing, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Jiangsu Nanjing, China
| | - Juan Wang
- Department of Pharmacy, Xinjiang Yili Friendship Hospital, Xinjiang Yili China
| | - Xiang Hui
- Department of Pharmacy, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Jiangsu Nanjing, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Jiangsu Nanjing, China
| | - Huai-Jun Zhu
- Department of Pharmacy, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Jiangsu Nanjing, China
| | - Bao-Yan Wang
- Department of Pharmacy, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Jiangsu Nanjing, China
| | - Hang Xu
- Department of Pharmacy, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Jiangsu Nanjing, China
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Wang G, Kong B, Qin T, Liu Y, Huang C, Huang H. Incidence, risk factors, and clinical impact of peridevice leak following left atrial appendage closure with the LAmbre device-Data from a prospective multicenter clinical study. J Cardiovasc Electrophysiol 2020; 32:354-359. [PMID: 33251673 DOI: 10.1111/jce.14824] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the present study, we sought to explore the incidence, risk factors, and clinical impact of peridevice leaks (PDLs), following LAmbre-assisted left atrial appendage closure (LAAC). METHODS We performed transesophageal echocardiography (TEE) on patients participating in the LAmbre multicenter study, at Day 1 postimplantation, then at 3 and 12 months to assess PDL, device-related thrombus, left atrial appendage (LAA) thrombus, and left atrial thrombus. Clinical events were recorded during follow-up. RESULT A total of 152 patients with atrial fibrillation successfully completed LAAC. At 3 months follow-up, 123 patients underwent TEE, with 21 (17%) of them presenting PDL. Among the 121 patients who underwent TEE at 12 months follow-up, 19 (15.7%) presented PDL. Patients with PDL exhibited larger LAA orifice diameters and larger device sizes compared to those in the no leak group. In addition, we found no significant differences in thromboembolic events between patients in the PDL and no leak groups. CONCLUSION LAmbre-assisted LAA closure resulted in a relatively low PDL occurrence, and its rate decreased over time. In addition, PDL was more prominent in patients with larger LAA orifice diameter and larger device size. However, the condition was not associated with an increased risk for thromboembolic events.
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Affiliation(s)
- Guangji Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Bin Kong
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Tianyou Qin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Yu Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - He Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Cardiovascular Research Institute of Wuhan University, Wuhan, Hubei, China.,Department of Cardiology, Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
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9
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Left Atrial Appendage Mechanical Exclusion: Procedural Planning Using Cardiovascular Computed Tomographic Angiography. J Thorac Imaging 2020; 35:W107-W118. [PMID: 32235186 DOI: 10.1097/rti.0000000000000504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Left atrial appendage (LAA) mechanical exclusion is being investigated for nonpharmacologic stroke risk reduction in selected patients with atrial fibrillation. There are multiple potential approaches in various stages of development and clinical application, each of which depends on specific cardiothoracic anatomic characteristics for optimal performance. Multiple imaging modalities can be utilized for application of this technology, with transesophageal echocardiography used for intraprocedural guidance. Cardiovascular computed tomographic angiography can act as a virtual patient avatar, allowing for the assessment of cardiac structures in the context of surrounding cardiac, coronary vascular, thoracic vascular, and visceral and skeletal anatomy, aiding preprocedural decision-making, planning, and follow-up. Although transesophageal echocardiography is used for intraprocedural guidance, computed tomographic angiography may be a useful adjunct for preprocedure assessment of LAA sizing and anatomic obstacles or contraindications to deployment, aiding in the assessment of optimal approaches. Potential approaches to LAA exclusion include endovascular occlusion, epicardial ligation, primary minimally invasive intercostal thoracotomy with thoracoscopic LAA ligation or appendectomy, and minimally invasive or open closure as part of cardiothoracic surgery for other indications. The goals of these procedures are complete isolation or exclusion of the entire appendage without leaving a residual appendage stump or residual flow with avoidance of acute or chronic damage to surrounding cardiovascular structures. The cardiovascular imager plays an important role in the preprocedural and postprocedural assessment of the patient undergoing LAA exclusion.
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Schnupp S, Liu X, Buffle E, Gloekler S, Mohrez Y, Cheikh‐Ibrahim M, Allakkis W, Brachmann J, Park J, Kleinecke C. Late clinical outcomes of lambre versus amplatzer occluders for left atrial appendage closure. J Cardiovasc Electrophysiol 2020; 31:934-942. [DOI: 10.1111/jce.14398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/02/2020] [Accepted: 02/06/2020] [Indexed: 12/24/2022]
Affiliation(s)
| | - Xiao‐Xia Liu
- Department of CardiologyThe 4th Hospital of Harbin Medical University Harbin China
- Department of CardiologyAnzhen Hospital, Capital Medical University Beijing China
| | - Eric Buffle
- Department of CardiologyUniversity Hospital of Bern Bern Switzerland
| | - Steffen Gloekler
- Department of CardiologyUniversity Hospital of Bern Bern Switzerland
- Department of CardiologySchwarzwald‐Baar Klinikum Villingen‐Schwenningen Germany
| | - Yamen Mohrez
- Department of CardiologyKlinikum Coburg Coburg Germany
| | | | | | | | - Jai‐Wun Park
- Department of CardiologyCharité Berlin‐University Medicine, Campus Benjamin Franklin Berlin Germany
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Ali M, Rigopoulos AG, Mammadov M, Torky A, Auer A, Matiakis M, Abate E, Bakogiannis C, Tzikas S, Bigalke B, Sedding D, Noutsias M. Systematic review on left atrial appendage closure with the LAmbre device in patients with non-valvular atrial fibrillation. BMC Cardiovasc Disord 2020; 20:78. [PMID: 32050904 PMCID: PMC7017553 DOI: 10.1186/s12872-020-01349-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Percutaneous closure (LAAC) of the left atrial appendage (LAA) is an efficacious preventive procedure for patients with non-valvular atrial fibrillation (NVAF) and considerable bleeding risk. We sought to systematically review the available LAAC data on the novel occluder device LAmbre™. METHODS For this systematic review, a search of the literature was conducted by 3 independent reviewers, reporting the safety and therapeutic success of LAAC in patients being treated with a LAmbre™. Publications reporting the safety and therapeutic success of LAAC using LAmbre™ in n > 5 patients were included. RESULTS The literature search retrieved n = 10 publications, encompassing n = 403 NVAF patients treated with a LAmbre™ LAAC, with relevant data regarding safety and therapeutic success of the procedure. The mean CHA2DS2-VASc Score was 4.0 + 0.9, and the mean HAS-BLED score was 3.4 + 0.5. The implantation success was 99.7%, with a mean procedure time of 45.4 ± 18.7 min, and a fluoroscopy time of 9.6 ± 5.9 min, and a contrast agent volume of 96.7 ± 0.7 ml. The anticoagulation regimen was switched to DAPT post procedure in the majority of the patients (96.8%). Partial and full recapture were done in 45.5% and in 25.6%, respectively. Major complications were reported in 2.9%, with 0.3% mortality, 1.7% pericardial tamponade, 0.3% stroke, and 0.6% major bleeding complications; no device embolization was observed. During follow up at 6 or 12 months, major adverse cardiovascular events were reported in 3.3%: Stroke or TIA in 1.7%, thrombus formation on the device in 0.7%, and residual flow > 5 mm in 1.0%. In some publications, the favorable implantion properties of the LAmbre™ for difficult anatomies such as shallow or multilobular LAA anatomies were described. CONCLUSIONS This systematic review on the LAmbre™ LAA-occluder including n = 403 NVAF patients demonstrates an excellent implantion success rate, promising follow-up clinical data, and favorable properties for also challenging LAA anatomies,. While its design seems to be helpful in preventing device embolization, pericardial tamponade may not be substantially reduced by the LAmbre™ as compared with other established LAAC devices. Further larger prospective multicenter registries and randomized trials are needed to scrutinize the value of the LAmbre™ compared with established LAAC devices.
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Affiliation(s)
- Muhammad Ali
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Angelos G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Mammad Mammadov
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Abdelrahman Torky
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Andrea Auer
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Marios Matiakis
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Elena Abate
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Constantinos Bakogiannis
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Stergios Tzikas
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Boris Bigalke
- Department of Cardiology, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Daniel Sedding
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany.
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Chen S, Schmidt B, Tohoku S, Trolese L, Bordignon S, Chun KRJ. Transesophageal echocardiography-guided closure of electrically isolated left atrial appendage to constrain a rapidly growing thrombus despite anticoagulation and sinus rhythm. J Cardiovasc Electrophysiol 2019; 31:247-249. [PMID: 31749201 DOI: 10.1111/jce.14284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Luca Trolese
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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13
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Percutaneous left atrial appendage closure using the LAmbre device. First clinical results in Poland. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:251-254. [PMID: 31497060 PMCID: PMC6727234 DOI: 10.5114/aic.2019.86019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/28/2019] [Indexed: 11/17/2022] Open
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Reinsch N, Ruprecht U, Buchholz J, Edel C, Kälsch H, Neven K. Initial experience of percutaneous left atrial appendage closure using the LAmbre device for thromboembolic prevention. J Cardiovasc Med (Hagerstown) 2019; 19:491-496. [PMID: 29894355 DOI: 10.2459/jcm.0000000000000663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Stroke due to atrial fibrillation has been associated with a high risk of disability and mortality. Percutaneous left atrial appendage (LAA) closure has been established as an alternative strategy for stroke prevention in patients not eligible for oral anticoagulation. The LAmbre is a novel occluder, specifically designed for LAA closure adaptive to various LAA anatomies. The aim of this study was to demonstrate feasibility and initial experience in a nonprescreened patient cohort for LAA occlusion using the novel LAmbre occluder. METHODS The device was implanted in 11 patients with nonvalvular atrial fibrillation. Follow-up included transesophageal echocardiography and an outpatient visit at 6 weeks and 6 months after implantation. RESULTS All devices were implanted successfully. Device sizes ranged from 16/22 to 22/34 mm. Patients' mean CHA2DS2-VASc and HAS-BLED scores were 3.3 ± 1.0 and 3.2 ± 1.0, respectively. Two out of 11 patients had previously been rejected for Watchman occluder implantation by reasons of too small LAA. At 6 weeks and 6 months, there were no deaths, strokes, systemic thromboembolism or severe bleeding complications. There was no device-related thrombus or pericardial effusion seen with transesophageal echocardiography. In one out of 11 patients, a minimal peridevice flow (less than 5 mm) was present at 6-week follow-up. CONCLUSION The LAmbre occluder is a novel LAA-closure device with features that provide many options for LAA-closure to physicians, particularly in patients with challenging anatomies. From our initial experience, implantation is associated with a good success rate and clinical outcome.
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Affiliation(s)
- Nico Reinsch
- Department of Electrophysiology, Alfried Krupp Krankenhaus.,University Witten/ Herdecke, Witten
| | - Ute Ruprecht
- Department of Electrophysiology, Alfried Krupp Krankenhaus.,Department of Cardiology, Evangelisches Krankenhaus Essen-Werden, Essen.,University Witten/ Herdecke, Witten
| | | | - Christoph Edel
- Department of Cardiology, Alfried Krupp Krankenhaus, Essen, Germany
| | - Hagen Kälsch
- University Witten/ Herdecke, Witten.,Department of Cardiology, Alfried Krupp Krankenhaus, Essen, Germany
| | - Kars Neven
- Department of Electrophysiology, Alfried Krupp Krankenhaus.,University Witten/ Herdecke, Witten
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15
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Chen S, Schmidt B, Bordignon S, Perrotta L, Bologna F, Nagase T, Chun KRJ. Left appendage isolation plus left appendage occlusion on top of pulmonary vein isolation, a therapeutic option for a PVI nonresponder with persistent atrial fibrillation? J Cardiovasc Electrophysiol 2019; 30:1177-1178. [DOI: 10.1111/jce.13881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Shaojie Chen
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Boris Schmidt
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Stefano Bordignon
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Laura Perrotta
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Fabrizio Bologna
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - Takahiko Nagase
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
| | - K. R. Julian Chun
- Frankfurt Academy For Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III; Agaplesion Markus Krankenhaus; Frankfurt am Main Germany
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Chen S, Chun KRJ, Bordignon S, Weise FK, Nagase T, Perrotta L, Bologna F, Schmidt B. Left atrial appendage occlusion using LAmbre Amulet and Watchman in atrial fibrillation. J Cardiol 2018; 73:299-306. [PMID: 30583991 DOI: 10.1016/j.jjcc.2018.10.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/11/2018] [Accepted: 10/23/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Left atrial appendage closure (LAAC) has been suggested as an alternative to anticoagulation in non-valvular atrial fibrillation (AF). The present study aimed to compare a LAmbre LAA occluder system [Lifetech Scientific (Shenzhen) Co. Ltd., Shenzhen, China] with the most investigated Amulet (St. Jude Medical Inc., St. Paul, MN, USA) and Watchman (Boston Scientific, Plymouth, MN, USA) devices in terms of peri-procedural and short-term outcomes. METHODS This is a prospective observational study. RESULTS Overall, 140 patients (50 female, mean age 76.2±8.4 years) were consecutively enrolled. Mean CHA2DS2-VASc score was 3.8±1.5, and mean HAS-BLED score was 3.9±1.1. Baseline clinical characteristics were comparable between the three groups (LAmbre, n=30; Amulet, n=74; Watchman, n=36); the LAmbre group had significantly more patients with complicated LAA morphology (p=0.006). The implant success rate was 100% in LAmbre, 99% in Amulet, and 100% in Watchman group (p=0.638). The number of device repositions was not significantly different between groups (0.7±1.1 in LAmbre, 1.0±2.0 in Amulet, and 1.4±1.8 in Watchman group, p=0.345). Fluoroscopic and procedural times were similar between groups. Major peri-procedural adverse events did not differ between groups (0% vs. 0% vs. 2.8%, p=0.233). Six months' follow-up showed good device stability and patients' clinical condition in all groups. CONCLUSION LAmbre, Amulet, and Watchman exhibit remarkable implant success rate, low risk of peri-procedural adverse events, and good clinical outcomes.
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Affiliation(s)
- Shaojie Chen
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
| | - K R Julian Chun
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
| | - Stefano Bordignon
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Felix K Weise
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Takahiko Nagase
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Laura Perrotta
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
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Chen S, Weise FK, Chun KRJ, Schmidt B. Antithrombotic strategies after interventional left atrial appendage closure: an update. Expert Rev Cardiovasc Ther 2018; 16:675-678. [PMID: 30095350 DOI: 10.1080/14779072.2018.1510316] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Interventional left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation (OAC) therapy for the prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF). Areas covered: Antithrombotic therapy following interventional LAAO is critical in balancing the risk of thromboembolism and bleeding during the endothelialization of the implanted devices. In this article, the most recent clinical trials are reviewed and the current real-world antithrombotic strategies following LAAO device implantation are discussed. Expert commentary: For patients eligible for OAC and receiving a Watchman device, the most solid scientific evidence exists for warfarin plus aspirin for 45 days followed by dual antiplatelet therapy (DAPT) for 6 months and a lifelong aspirin therapy. In real-world most patients are being treated with DAPT for 3-6 months. Alternatively, the Watchman was approved for 3 months of novel OAC (NOAC) therapy in conjunction with aspirin. For all other devices, DAPT for 1-6 months has been used in the vast majority of cases. Considering major bleeding as the predominant complication following LAAO, evidence suggests that short-term DAPT (6 weeks) or single antiplatelet therapy using aspirin may be a viable option.
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Affiliation(s)
- Shaojie Chen
- a Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main , Frankfurt am Main , Germany
| | - Felix K Weise
- a Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main , Frankfurt am Main , Germany
| | - K R Julian Chun
- a Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main , Frankfurt am Main , Germany
| | - Boris Schmidt
- a Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main , Frankfurt am Main , Germany
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Left atrial appendage occlusion with lambre in atrial fibrillation: Initial European experience. Int J Cardiol 2018; 265:97-102. [DOI: 10.1016/j.ijcard.2018.02.120] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/08/2018] [Accepted: 02/28/2018] [Indexed: 01/15/2023]
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Kleinecke C, Gomez Monterrosas O, Scalone G, Lam YY, Shin ES, Bellmann B, Brachmann J, Park JW. First-in-human experience of left atrial appendage occlusion with the steerable FuStar sheath. J Interv Cardiol 2018; 31:532-537. [PMID: 29582475 DOI: 10.1111/joic.12509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/25/2018] [Accepted: 03/01/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Due the wide variability of left atrial appendage morphology left atrial appendage occlusion (LAAO) remains a challenging procedure. The steerable FuStar delivery sheath was designed to allow both, transseptal access and delivery of percutaneous devices. We here report the first-in-human experience of LAAO with the FuStar sheath. METHODS Twenty patients (76.6 ± 8.4 years; 12 (60%) males; CHA2 DS2 -VASc score: 5.0 ± 2) with non-valvular fibrillation and contraindications to oral anticoagulation underwent LAAO with the LAmbre device using the FuStar steerable sheath (Lifetech Scientific Corp., Shenzhen, China) at two german centers. RESULTS Successful device implantation was achieved in all patients (100%). No periprocedural complications were observed. Procedure time, fluoroscopy time, contrast media, and radiation dose were 23.4 min ± 9.2, 11.9 min ± 4.1, 96.2 mL ± 45.7, and 2718.4 cG*cm2 ± 3835.3, respectively. CONCLUSION This study demonstrates the feasibility and safety of the steerable FuStar sheath for LAAO.
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Affiliation(s)
| | | | - Giancarla Scalone
- Department of Cardiology, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - Yat-Yin Lam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Eun-Seok Shin
- Department of Cardiology, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - Barbara Bellmann
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | | | - Jai-Wun Park
- Department of Cardiology, Klinikum Coburg, Coburg, Germany.,Department of Cardiology, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany.,Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
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