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Wang B, Chu H, Wang Z, Fu G, Yu Y, Feng M, Du X. Left atrial appendage closure in patients with left atrial appendage thrombus guided by intracardiac echocardiography. Heart Rhythm 2024; 21:812-818. [PMID: 38272283 DOI: 10.1016/j.hrthm.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Data regarding left atrial appendage closure (LAAC) in patients with left atrial appendage (LAA) thrombus are limited. Recently published cases have mostly been guided by transesophageal echocardiography. Intracardiac echocardiography (ICE) is now widely used during LAAC procedures. OBJECTIVE This is the first study to report the feasibility of LAAC in patients with LAA thrombus guided by ICE. METHODS Patients with persistent LAA thrombus despite anticoagulation or contraindications to anticoagulation who underwent a modified ICE-guided LAAC procedure between June 2021 and April 2023 were included. Periprocedural events and clinical outcomes during follow-up were recorded. RESULTS A total of 12 patients (mean age 65 ± 7 years; 92% male) were included: 10 with persistent LAA thrombus and 2 with contraindications to anticoagulation. Most of the thrombus was at the apex (n = 6), followed by the body (n = 3) and the ostium (n = 3). A LAmbre device was used and successfully implanted in all patients with the guidance of ICE. No thrombotic material was retrieved from patients with the protection of cerebral protection device (n = 11). No patient experienced severe periprocedural complications. All patients completed transesophageal echocardiography follow-up, and no device-related thrombus or peridevice leak > 3 mm was detected. None of the patients experienced stroke/transient ischemic attack, systemic embolism, or major bleeding events during a median follow-up of 147 days (interquartile range 80-306 days). CONCLUSION LAAC using the LAmbre device guided by ICE may be feasible in patients with LAA thrombus when performed by experienced operators.
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Affiliation(s)
- Binhao Wang
- Arrhythmia Center, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, China
| | - Huimin Chu
- Arrhythmia Center, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, China.
| | - Zhao Wang
- Department of Ultrasonography, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Guohua Fu
- Arrhythmia Center, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, China
| | - Yibo Yu
- Arrhythmia Center, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, China
| | - Mingjun Feng
- Arrhythmia Center, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, China
| | - Xianfeng Du
- Arrhythmia Center, First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, China
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Zhang Z, Zhou J, Lin Q, Wang C, Huang Y, Dai Y, Zuo W, Liu N, Xiao Y, Liu Q. Overcoming barriers for left atrial appendage thrombus: a systematic review of left atrial appendage closure. BMC Cardiovasc Disord 2024; 24:175. [PMID: 38515032 PMCID: PMC10956221 DOI: 10.1186/s12872-024-03843-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Approximately 90% of intracardial thrombi originate from the left atrial appendage in non-valvular atrial fibrillation patients. Even with anticoagulant therapy, left atrial appendage thrombus (LAAT) still occurs in 8% of patients. While left atrial appendage closure (LAAC) could be a promising alternative, the current consensus considers LAAT a contraindication to LAAC. However, the feasibility and safety of LAAC in patients with LAAT have yet to be determined. METHODS This systematic review synthesizes published data to explore the feasibility and safety of LAAC for patients with LAAT. RESULTS This study included a total of 136 patients with LAATs who underwent successful LAAC. The Amulet Amplatzer device was the most frequently utilized device (48.5%). Among these patients, 77 (56.6%) had absolute contraindications to anticoagulation therapy. Cerebral protection devices were utilized by 47 patients (34.6%). Transesophageal echocardiography (TEE) is the primary imaging technique used during the procedure. Warfarin and novel oral anticoagulants were the main anticoagulant medications used prior to the procedure, while dual antiplatelet therapy was primarily used post-procedure. During a mean follow-up period of 13.2 ± 11.5 months, there was 1 case of fatality, 1 case of stroke, 3 major bleeding events, 3 instances of device-related thrombus, and 8 cases of peri-device leakage. CONCLUSIONS This review highlights the preliminary effectiveness and safety of the LAAC procedure in patients with persistent LAAT. Future large-scale RCTs with varied LAAT characteristics and LAAC device types are essential for evidence-based decision-making in clinical practice.
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Affiliation(s)
- Zixi Zhang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Hunan Province, Changsha, 410011, People's Republic of China
| | - Jiabao Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Hunan Province, Changsha, 410011, People's Republic of China
| | - Qiuzhen Lin
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Hunan Province, Changsha, 410011, People's Republic of China
| | - Cancan Wang
- Department of Metabolic Endocrinology, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, 410011, People's Republic of China
| | - Yunying Huang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Hunan Province, Changsha, 410011, People's Republic of China
| | - Yongguo Dai
- Department of Pharmacology, Wuhan University TaiKang Medical School (School of Basic Medical Sciences), Hubei Province, Wuhan, 430071, People's Republic of China
| | - Wanyun Zuo
- Department of Hematology, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, 410011, People's Republic of China
| | - Na Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Hunan Province, Changsha, 410011, People's Republic of China
| | - Yichao Xiao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Hunan Province, Changsha, 410011, People's Republic of China.
| | - Qiming Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Hunan Province, Changsha, 410011, People's Republic of China.
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Jin LS, Ke JY, Lin YN, Li L, Fu JY, Chen YL, Qiu YX, Li XW, Pan YQ, Li YC. Percutaneous left atrial appendage closure using the LAmbre device in patients with atrial fibrillation and left atrial appendage thrombus. Front Cardiovasc Med 2022; 9:1071119. [PMID: 36505354 PMCID: PMC9729287 DOI: 10.3389/fcvm.2022.1071119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
Background Left atrial appendage closure (LAAC) is considered a valid alternative for the prevention of thromboembolic stroke in patients with persistent left atrial appendage thrombus (LAAT) despite adequate anticoagulation. However, the data on LAAC using the LAmbre device for patients with LAAT is limited. This study was performed to explore efficacy and safety as well as to share the experience of the modified LAAC procedure with the LAmbre device. Materials and methods A total of 7 patients with persistent LAAT despite adequate anticoagulation underwent modified LAAC with the LAmbre device between November 2019 and April 2022. Transesophageal echocardiography was performed 3 months postoperatively to detect device-related thrombosis and peridevice leak. The patients' clinical events were evaluated during the perioperative and follow-up periods. Results The median age, CHA2DS2-VASc score, and HAS-BLED score of all patients were 71 [53-73], 3 [2-4], and 2 [2-3], respectively. In the procedure, a cerebral protection system was used in two patients. LAAC with the LAmbre device was successfully performed in all patients without perioperative events. During the median follow-up of 383 [325-865] days, postoperative transesophageal echocardiography was performed in six (85.7%) patients. Device-related thrombosis was detected in one (16.7%) patient, and no significant peridevice leak was observed. No thromboembolic event or bleeding event occurred in any patients. Conclusion LAAC with the LAmbre device is effective and safe when performed by experienced operators in highly selected patients with LAAT after adequate anticoagulation.
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Tohoku S, Chen S, Bordignon S, Chun JK, Schmidt B. Hot or cold? Feasibility, safety, and outcome after radiofrequency‐guided versus cryoballoon‐guided left atrial appendage isolation. J Arrhythm 2022; 38:316-326. [PMID: 35785393 PMCID: PMC9237309 DOI: 10.1002/joa3.12691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III Agaplesion Markus Krankenhaus Frankfurt am Main Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III Agaplesion Markus Krankenhaus Frankfurt am Main Germany
- Die Sektion Medizin Universität zu Lübeck Lübeck 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
| | - Julian Kyoung‐Ryul Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III Agaplesion Markus Krankenhaus Frankfurt am Main Germany
- Die Sektion Medizin Universität zu Lübeck Lübeck 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
- Universitätsklinikum Frankfurt Medizinische Klinik 3‐ Klinik für Kardiologie Frankfurt Germany
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Limite LR, Radinovic A, Cianfanelli L, Altizio S, Peretto G, Frontera A, D'Angelo G, Baratto F, Marzi A, Ancona F, Ingallina G, Capogrosso C, Stella S, Melillo F, Agricola E, Della Bella P, Mazzone P. Outcome of left atrial appendage closure using cerebral protection system for thrombosis: no patient left behind. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:23-34. [PMID: 34841552 DOI: 10.1111/pace.14398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/26/2021] [Accepted: 10/31/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Left atrial appendage (LAA) thrombosis increases the risk of stroke and its management has to be assessed. The aim of the present study is to evaluate short and long-term safety and efficacy of a standardized approach of percutaneous LAA closure (LAAC) routinely using a cerebral protection device (CPD) in patients with LAA thrombosis or sludge (LAAT). METHODS We prospectively enrolled 14 consecutive patients with atrial fibrillation complicated by LAAT presenting in a high-volume tertiary center. In seven patients (50%) LAAT was found after anticoagulant withdrawal for severe bleedings and in the remaining half LAAT was found despite appropriate anticoagulant therapy. All patients were treated with a standardized interventional approach of LAAC routinely using a CPD and guided by transoesophageal echocardiography. RESULTS Mean age was 68 ± 14 years and nine patients (64%) were male. Mean CHA2 DS2 -VASc and HAS-BLED scores were 3.3 ± 1.6 and 2.3 ± 1.1, respectively. Six patients (42.8%) presented organized thrombi while eight LAA sludge (57.1%). In 13 patients (92.8%) CPD was positioned through a right radial arterial access. Procedural success was achieved in all patients. In one patient we assisted to embolization of the thrombus during deployment of the device in the absence of neurological consequences. During a mean follow up of 426 ± 307 days, one patient died for non-cardiac cause while no embolic event or major bleeding were reported. CONCLUSION In an unselected cohort, LAAC with the systematic use of CPD was a feasible, safe and effective therapeutic option for LAAT both acutely and after long-term follow-up.
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Affiliation(s)
- Luca Rosario Limite
- Department of Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Radinovic
- Department of Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Cianfanelli
- Cardiac Rehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Savino Altizio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Peretto
- Department of Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Frontera
- Department of Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe D'Angelo
- Department of Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Baratto
- Department of Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Marzi
- Department of Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Ingallina
- Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Capogrosso
- Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Stella
- Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Melillo
- Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Della Bella
- Department of Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizio Mazzone
- Department of Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Kaczmarek K, Cygankiewicz I, Streb W, Plaksej R, Jakubowski P, Kalarus Z, Ptaszynski P, Wranicz JK, Babicz-Sadowska A, Markiewicz A, Grygier M. Percutaneous Occlusion of the Left Atrial Appendage with Thrombus Irresponsive to Antithrombotic Therapy. J Clin Med 2021; 10:jcm10040726. [PMID: 33673147 PMCID: PMC7918449 DOI: 10.3390/jcm10040726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
We analyzed clinical experience with percutaneous closure of instances of left atrial appendage with thrombus (LAAT) irresponsive to antithrombotic therapy in patients treated in three high-volume cardiology centers. Clinical and procedural data regarding consecutive patients who underwent percutaneous left atrial appendage closure (PLAAC) due to LAAT were retrospectively analyzed. The study population consisted of 17 patients (11 men; 68 ± 14 years; CHA2DS2VASC 4.7 ± 1.9; HASBLED 3 (0-5)) with LAAT confirmed by transesophageal echocardiography, and included 5 patients with mechanical heart valves. Most of the patients (94.1%) received anticoagulation therapy before PLAAC. All LAATs were located in distal portions of the appendage and occupied less than 30% of its volume. Occluding-device implantation was successful in 17 patients; in one, a residual leak was disclosed. Appropriate positioning of occluders required more than 1 attempt in 6 individuals (35.3%); in 3 others (17.6%), the subjects' devices had contact with thrombi. No procedural complications were noted. Midterm follow-up (median: 10 months) revealed no procedure-related complications or clinically diagnosed thromboembolism. Transesophageal echocardiography (TEE) performed after six months revealed device-related thrombus in one patient. We concluded that LAAT irresponsive to antithrombotic therapy might be effectively treated with PLAAC, even in patients with mechanical-valve prostheses.
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Affiliation(s)
- Krzysztof Kaczmarek
- Department of Electrocardiology, Medical University of Lodz, Pomorska Str 251, 92-213 Lodz, Poland; (I.C.); (P.J.); (P.P.); (J.K.W.)
- Correspondence: ; Tel.: +48-604-960-450
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Pomorska Str 251, 92-213 Lodz, Poland; (I.C.); (P.J.); (P.P.); (J.K.W.)
| | - Witold Streb
- Silesian Center for Heart Disease, 1st Department of Cardiology and Angiology, 41-800 Zabrze, Poland; (W.S.); (Z.K.)
| | - Rafal Plaksej
- Regional Center of Cardiology, Copper Medical Center 66 M. Skłodowska–Curie St., 59-300 Lubin, Poland; (R.P.); (A.B.-S.)
| | - Piotr Jakubowski
- Department of Electrocardiology, Medical University of Lodz, Pomorska Str 251, 92-213 Lodz, Poland; (I.C.); (P.J.); (P.P.); (J.K.W.)
| | - Zbigniew Kalarus
- Silesian Center for Heart Disease, 1st Department of Cardiology and Angiology, 41-800 Zabrze, Poland; (W.S.); (Z.K.)
| | - Pawel Ptaszynski
- Department of Electrocardiology, Medical University of Lodz, Pomorska Str 251, 92-213 Lodz, Poland; (I.C.); (P.J.); (P.P.); (J.K.W.)
| | - Jerzy Krzysztof Wranicz
- Department of Electrocardiology, Medical University of Lodz, Pomorska Str 251, 92-213 Lodz, Poland; (I.C.); (P.J.); (P.P.); (J.K.W.)
| | - Anna Babicz-Sadowska
- Regional Center of Cardiology, Copper Medical Center 66 M. Skłodowska–Curie St., 59-300 Lubin, Poland; (R.P.); (A.B.-S.)
| | - Agata Markiewicz
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga1/2, 61-848 Poznan, Poland; (A.M.); (M.G.)
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Dluga1/2, 61-848 Poznan, Poland; (A.M.); (M.G.)
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