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Lisette Wintgens, Aleksandr Romanov, Karen Phillips, Gabriel Ballesteros, Martin Swaans, Richard Folkeringa, Ignacio Garcia-Bolao, Evgeny Pokushalov, Lucas Boersma
Aims: Long-term freedom from atrial fibrillation (AF) after catheter ablation (CA) and consequently the potential for stroke reduction remain unpredictable. Percutaneous left atrial appendage closure (LAAC) is an effective mechanical alternative to oral anticoagulation (OAC) for stroke prevention in AF patients. This study aims to evaluate long-term clinical results of combined CA and LAAC in one single procedure. Methods and results: Patients with non-valvular AF who underwent combined CA and LAAC procedure were included in the retrospective compilation of independent prospective general LAAC registries at the individual centres...
March 13, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Cheng Jin, Jianjiang Feng, Lei Wang, Heng Yu, Jiang Liu, Jiwen Lu, Jie Zhou
In this paper, we present an approach for left atrial appendage (LAA) multi-phase fast segmentation and quantitative assisted diagnosis of atrial fibrillation (AF) based on 4D-CT data. We take full advantage of the temporal dimension information to segment the living, flailed LAA based on a parametric max-flow method and graph-cut approach to build 3-D model of each phase. To assist the diagnosis of AF, we calculate the volumes of 3-D models, and then generate a "volume-phase" curve to calculate the important dynamic metrics: ejection fraction, filling flux, and emptying flux of the LAA's blood by volume...
March 9, 2018: Computers in Biology and Medicine
Hui Zhu, Zhixing Li, Jinglei Lv, Renliang Zhao
OBJECTIVE: Cerebral small vessel disease (CSVD) describes a syndrome of neuroimaging, pathological, and associated clinical features caused by small intracranial vascular lesions, which commonly coexists with large artery atherosclerosis (LAA) and has been identified as a major cause of motor impairment over time. In this review, we aim to summarize the relationship between CSVD and LAA, and discuss the effects of CSVD on the clinical outcome of patients with ischemic stroke caused by LAA...
March 15, 2018: Neurological Research
Emmanuel Teiger, Jean-Benoit Thambo, Pascal Defaye, Jean-Sylvain Hermida, Sélim Abbey, Didier Klug, Jean-Michel Juliard, Jean-Luc Pasquie, Gilles Rioufol, Antoine Lepillier, Meyer Elbaz, Jerome Horvilleur, Philippe Brenot, Bertrand Pierre, Philippe Le Corvoisier
BACKGROUND: Percutaneous left atrial appendage (LAA) closure is an emerging option for patients with atrial fibrillation at high risk for cerebrovascular events. The multicenter FLAAC registry (French Nationwide Observational LAA Closure Registry) was established to assess LAA closure outcomes in everyday practice. METHODS AND RESULTS: Four hundred thirty-six patients referred from April 2013 to September 2015 to 33 French interventional cardiology centers for percutaneous LAA closure were included prospectively in the FLAAC registry...
March 2018: Circulation. Cardiovascular Interventions
Yojiro Makino, Yoshihisa Shimada, Masaru Hagiwara, Masatoshi Kakihana, Jinho Park, Naohiro Kajiwara, Tatsuo Ohira, Norihiko Ikeda
OBJECTIVES: Emphysema is one of the main causes of respiratory complications in patients operated on for lung cancer. We have used three-dimensional computed tomography (3D CT) for surgical simulations, as well as for depicting emphysematous areas as low attenuation areas (LAAs) and visual scores based on the Goddard classification (Goddard score), which is a visual scale of the area of vascular disruption and LAA for each lung field. This study aimed to investigate the effectiveness of the 3D CT function for assessing emphysema severity and its association with respiratory complications...
March 12, 2018: European Journal of Cardio-thoracic Surgery
Yoshinari Enomoto, Go Hashimoto, Naohiko Sahara, Hikari Hashimoto, Hiroki Niikura, Keijiro Nakamura, Raisuke Iijima, Hidehiko Hara, Makoto Suzuki, Mahito Noro, Masao Moroi, Kaoru Sugi, Masato Nakamura
A 70-years-old male with a history of hypertension and drug resistant paroxysmal atrial fibrillation (AF) presented to our hospital for catheter ablation to his symptomatic AF. He had no prior surgical or percutaneous procedure to close or exclude the left atrial appendage (LAA). A transesophageal echocardiography (TEE) was performed to rule out intra-cardiac thrombus prior to the ablation procedure. Although the TEE imaging at multiple acquisition angles was obtained, the LAA could not be visualized and an absence of the LAA was suspected...
March 12, 2018: International Heart Journal
Matthew J Price
Randomized clinical trials have demonstrated that left atrial appendage (LAA) closure with the WATCHMAN device provides stroke prevention in nonvalvular atrial fibrillation while significantly reducing morality and major bleeding. Technical and procedural considerations are paramount for the therapeutic success. Maximizing procedural safety is critical. Optimal LAA sealing is required. Improvements in procedural technique and operator training have resulted in a marked reduction in adverse procedural events, which should increase the absolute long-term clinical benefit...
April 2018: Interventional Cardiology Clinics
Matthew J Price
Resection of the left atrial appendage (LAA) to prevent recurrent arterial emboli in patients with atrial fibrillation was first suggested more than 60 years ago. Longer-term follow-up from randomized studies of the safety and efficacy of transcatheter LAA occlusion has recently been completed; data from large, observational cohorts are being reported. These recent data provide further insights into procedural safety with current techniques and the ability of LAA closure to reduce thromboembolic stroke compared with warfarin anticoagulation...
April 2018: Interventional Cardiology Clinics
Witold Streb, Katarzyna Mitręga, Tomasz Podolecki, Magdalena Szymała, Anna Leopold-Jadczyk, Tomasz Kukulski, Zbigniew Kalarus
BACKGROUND: Real-time three-dimensional transesophageal echocardiography (RT3D TEE) enables better visualization of the left atrial appendage (LAA) and may be superior to real-time two-dimensional transesophageal echocardiography (RT2D TEE) for LAA occlusion (LAAO). The aim of this study was to assess inter- and intra-observer variability of RT2D TEE and RT3D TEE measurements of LAA, and to assess the accordance of RT2D TEE and RT3D TEE with appropriate occluder selection. METHODS: Transesophageal echocardiography was performed in 40 patients during LAAO...
March 7, 2018: Cardiology Journal
Yemei He, Baixue Zhang, Fang Zhu, Zheyu Hu, Jia Zhong, Wenhui Zhu
AIMS: Paroxysmal atrial fibrillation (PAF) commonly recurs after radiofrequency catheter ablation (RFCA). This study aimed to assess left atrial appendage (LAA) volume and function by transesophageal echocardiography (TEE) and to explore its value in predicting PAF recurrence after RFCA. METHODS: Eighty patients with PAF were recruited. The left atrial (LA) and LAA volume and function were measured by transthoracic echocardiography (TTE) and TEE before ablation...
March 6, 2018: Echocardiography
Christian Fastner, Christoph A Nienaber, Jai-Wun Park, Johannes Brachmann, Uwe Zeymer, Martin Goedde, Horst Sievert, Volker Geist, Thorsten Lewalter, Alexander Krapivsky, Matthias Käunicke, Jens Maier, Belgin Özdemir, Matthias Hochadel, Steffen Schneider, Jochen Senges, Ibrahim Akin
AIMS: The interventional left atrial appendage closure (LAAC) is an emerging alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) in concomitance with a contraindication for standard OAC. This subanalysis of the LAARGE registry aims to investigate on differences between different LAA morphologies in a real-world setting. METHODS AND RESULTS: This prospective, multicenter, observational registry included 562 patients from 37 centers with ineligibility for long-term OAC between April 2014 and January 2016...
March 6, 2018: EuroIntervention
Albert C Lin, Bradley P Knight
Interventional catheter ablation approaches to the rhythm control of atrial fibrillation (AF) have advanced significantly in the past decade. The foundation of the catheter ablation in AF is electrical isolation of the pulmonary veins (PVI). However, PVI only in more advanced stages of AF (persistent AF) has only modest to poor success rates prompting a search for alternative and adjunctive procedures to improve the outcomes of ablation in persistent AF. The left atrial appendage (LAA) is well understood to be a primary source of emboli in AF but less well known be a trigger or driver for AF...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
Hiroki Usuku, Eiichiro Yamamoto, Hiromi Yoshimura, Ryusuke Tsunoda, Kazuhiro Nishigami, Masamichi Nakajima, Ryusuke Suzuki, Kenichi Tsujita
We detected symptomatic atrial fibrillation in a 64-year-old man who had undergone mitral valvuloplasty. While performing transesophageal echocardiography (TEE) in the left lateral decubitus position, we detected an isoechoic mass lesion at the bottom of the left atrial appendage (LAA). After changing the patient's position from left to right, the mass lesion dropped down from the bottom of the LAA, spread out into the left atrium, and appeared as a spontaneous echocardiographic contrast with mobility. We therefore diagnosed the mass lesion as not a thrombus but sludge...
March 5, 2018: Echocardiography
Sandeep Prabhu, Manish Kalla, Kah Y Peck, Aleksandr Voskoboinik, Alex Ja McLellan, Bupesh Pathik, Chrishan J Nalliah, Geoff R Wong, Hariharan Sugumar, Sonia M Azzopardi, Geoffrey Lee, Liang-Han Ling, Jonathan M Kalman, Peter M Kistler
BACKGROUND: Pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation (CA) in persistent AF (PeAF) although less successful than for PAF. Whether rapid or fibrillatory (PVAF) PV firing may identify PeAF patients more likely to benefit from a PV based approach, is unclear. OBJECTIVE: To determine the relationship between PV cycle length (PVCL) and PVAF outcome post CA. METHODS: Before ablation, the multipolar catheter was placed in each PV and the left atrial appendage (LAA) for 100 consecutive cycles...
March 1, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Joel T Zelt, Joshua H Jones, Daniel M Hirai, Trevor J King, Danilo C Berton, Kyra E Pyke, Denis E O'Donnell, J Alberto Neder
BACKGROUND: Cardiovascular diseases play a major role in morbidity and mortality in the earlier stages of COPD. We hypothesized that systemic vascular dysfunction would be present even in patients who are currently considered at "low-risk" for negative cardiovascular outcomes, i.e., those with largely preserved FEV1 , few exacerbations and only mild burden of respiratory symptoms (GOLD spirometric grade 1, clinical group A). METHODS: 16 patients (FEV1  = 86 ± 13%) and 16 age- and gender-matched controls underwent measurements of: a) central arterial stiffness by pulse wave velocity, b) brachial flow-mediated dilation and c) forearm muscle oxygenation by near-infrared spectroscopy...
March 2018: Respiratory Medicine
Tawseef Dar, Bharat Yarlagadda, James Vacek, Buddhadeb Dawn, Dhanunjaya Lakkireddy
Background: Bleeding complications especially gastrointestinal bleeding remains a major challenge associated with oral anticoagulation therapy (OAT) and often leads clinicians to withdraw oral anticoagulation therapy (OAT) . This exposes patients to risk of stroke and systemic thromboembolism (STE). Novel oral anticoagulants (NOACs) have proved no better when it comes to bleeding events and in fact studies have shown that overall NOACs are associated with higher incidence of gastrointestinal (GI) bleeding compared to warfarin ...
December 2017: Journal of Atrial Fibrillation
Matteo Cameli, Stefano Lunghetti, Giulia Elena Mandoli, Francesca Maria Righini, Matteo Lisi, Valeria Curci, Cristina Di Tommaso, Marco Solari, Dan Nistor, Annalaura Gismondi, Marta Focardi, Roberto Favilli, Sergio Mondillo
Background and Purpose: Atrial fibrillation (AF) has a high prevalence in the population and it is responsible for up to the 25% of the strokes in elderly people. The aim of our study was to assess the correlations of left atrial (LA) functional parameter, global peak atrial longitudinal strain (PALS), derived from speckle tracking echocardiography (STE), with transesophageal echocardiography (TEE) findings in patients with persistent AF undergoing TEE before electrical cardioversion or ablation procedures...
December 2017: Journal of Atrial Fibrillation
Kathirvel Subramaniam, Andrea Ibarra, Michael L Boisen
In this report, we provided details of periprocedural echocardiographic guidance for patients undergoing Amplatzer-Amulet device left atrial closure. Familiarity with left atrial appendage (LAA) occlusion devices and the required left atrial examination and measurements are key before device placement. Device placement is assisted by transesophageal echocardiography (TEE) and fluoroscopy, but TEE will be the main guide for patients with renal insufficiency in whom contrast dye use needs to be minimal. TEE is also used to confirm LAA occlusion with the device and finally detect complications throughout the procedure and into the postoperative period...
February 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Mehdi Trifa, Dmitry Tumin, Joseph D Tobias
BACKGROUND: The aim of this review was to evaluate the current evidence regarding the use of dexmedetomidine as an adjuvant to local anaesthetic agents (LAA) for caudal blockade anaesthesia and analgesia in children. METHODS: A literature search was performed of the Medline, Embase, and CINAHL databases using the keywords "dexmedetomidine" and "caudal". We included all studies that used caudal dexmedetomidine as an adjuvant to a LAA in children, excluding case reports, reviews, expert opinions, and animal studies...
February 22, 2018: Minerva Anestesiologica
Tawseef Dar, Muhammad R Afzal, Bharath Yarlagadda, Shelby Kutty, Quanliang Shang, Sampath Gunda, Anweshan Samanta, Jahnavi Thummaluru, Kedareeshwar S Arukala, Arun Kanmanthareddy, Madhu Reddy, Donita Atkins, Sudharani Bommana, Buddhadeb Dawn, Dhanunjaya Lakkireddy
BACKGROUND: Left atrial (LA) strain (Ƹ) and Ƹ rate (SR) analysis by two-dimensional speckle tracking echocardiography (STE) is a novel way of functional assessment of LA. OBJECTIVE: We studied the impact of LA appendage (LAA) exclusion by LARIAT epicardial ligation on the mechanical function of LA by performing Ƹ and SR analysis before and after the procedure. METHODS: A total of 66 patients who underwent successful LAA exclusion were included in this study...
February 22, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
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