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left atrial appendage management

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https://www.readbyqxmd.com/read/27910092/management-of-atrial-fibrillation-in-elderly-adults
#1
Yaanik Desai, Mikhael F El-Chami, Angel R Leon, Faisal M Merchant
Driven in large part by the aging of the population and the increasing prevalence of cardiovascular comorbidities associated with atrial fibrillation (AF), there is a burgeoning epidemic of AF in elderly adults. Although there is a large body of literature to guide management of people with AF, elderly adults with AF are frequently underrepresented in clinical trials. This review provides a contemporary update on management of elderly adults with AF with a particular focus on the two main clinical challenges that AF poses: stroke risk reduction and control of symptoms...
December 2, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27909512/concomitant-left-atrial-appendage-clipping-during-minimally-invasive-mitral-valve-surgery-technically-feasible-and-safe
#2
Ashraf Alqaqa Md, Shabiah Martin Md, Aiman Hamdan Md Facc, Fayez Shamoon Md Facc, Kourosh T Asgarian DO
BACKGROUND: It is believed that most of thrombi form in the left atrial appendage (LAA)before they emboli. Different surgical and percutaneouse approaches were suggested to manage the LAA. In this study we are evaluating the safety of clipping the LAA via minithoractotomy approach. METHOD: All consecutive patients who had minimally invasive mitral valve surgery with concomitant LAA clipping between December 2012 and February 2014 were included in the study. LAA exclusion was performed using AtriClip® LAA Exclusion System (Cincinnati, Ohio, AtriCure®)...
June 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27898435/percutaneous-left-atrial-appendage-closure-current-state-of-the-art
#3
Mohammad-Ali Jazayeri, Venkat Vuddanda, Valay Parikh, Dhanunjaya R Lakkireddy
PURPOSE OF REVIEW: The authors reviewed the seminal and more recent literature surrounding the major modalities for percutaneous left atrial appendage closure used in contemporary practice, with particular emphasis on safety and efficacy, technical challenges, and future developments. RECENT FINDINGS: Along with the continued practice of surgical left atrial appendage closure, which has evolved substantially with the advent of clipping techniques, a number of percutaneous methods have been developed to close the left atrial appendage with endocardial, epicardial, and hybrid approaches...
January 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/27875660/successful-use-of-targeted-temperature-management-after-repair-of-myocardial-rupture-from-blunt-chest-trauma-a-case-report
#4
Wook-Jin Choi, Yun Seok Kim, Jung Seok Hong, Jeong Won Kim
Targeted temperature management (TTM) improves survival and neurological outcome after nontraumatic cardiac arrest. However, TTM is not used widely after traumatic cardiac arrest because of concerns that it might exacerbate bleeding. We report the use of postarrest TTM after repair of blunt myocardial rupture. A 48-year-old man was admitted after being rescued from a major traffic accident by the local emergency service. Focused sonography showed pericardial fluid without cardiac tamponade. Computed tomography showed a large hematoma in the anterior mediastinum associated with hemopericardium...
November 22, 2016: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/27853971/evaluation-of-left-atrial-appendage-function-and-thrombi-in-patients-with-atrial-fibrillation-from-transthoracic-to-real-time-3d-transesophageal-echocardiography
#5
Ilaria Dentamaro, Domenico Vestito, Ennio Michelotto, Delia De Santis, Vittoria Ostuni, Christian Cadeddu, Paolo Colonna
The detection of embolic sources in patients with atrial fibrillation (AF) is important to guide anticoagulant therapy. Two-dimensional transesophageal echocardiography (TEE) is the gold standard to study left atrial appendage (LAA) anatomy and morphology, despite some false-positive diagnosis. We hypothesized that real time 3D TEE (RT3DTEE) is superior to 2DTEE in detecting and/or excluding LAA thrombi. We studied 93 patients with non-valvular AF (60 males, age = 67.1 ± 14.2 years) referred for electric cardioversion with transthoracic, 2DTEE and RT3DTEE...
November 17, 2016: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/27649848/intracardiac-versus-transesophageal-echocardiography-for-left-atrial-appendage-occlusion-with-watchman
#6
Antonio H Frangieh, Jasmina Alibegovic, Christian Templin, Oliver Gaemperli, Slayman Obeid, Robert Manka, Erik W Holy, Willibald Maier, Thomas F Lüscher, Ronald K Binder
BACKGROUND: Left atrial appendage occlusion (LAAO) is mostly performed by transesophageal echocardiography (TEE) guidance. Intracardiac echocardiography (ICE) may be an alternative imaging modality for LAAO that precludes the need for general anesthesia or sedation. METHODS AND RESULTS: All consecutive single center, single operator LAAO candidates were analyzed. Baseline clinical and procedural characteristics and in-hospital outcomes were compared between patients in whom a Watchman was implanted with ICE vs...
September 21, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27628431/left-atrial-appendage-occlusion-rationale-evidence-devices-and-patient-selection
#7
Jonathan P Piccini, Horst Sievert, Manesh R Patel
Atrial fibrillation (AF) is a worldwide epidemic associated with significant morbidity and mortality, often due to disabling or fatal thromboembolic stroke. Oral anticoagulation is highly effective at preventing ischaemic stroke and improving all-cause survival in patients with non-valvular AF. Despite the efficacy of oral anticoagulation, many patients are not treated due to either absolute or perceived contraindications to therapy, including bleeding. Left atrial appendage (LAA) closure has emerged as a mechanical alternative to pharmacologic stroke prevention...
September 13, 2016: European Heart Journal
https://www.readbyqxmd.com/read/27581874/cost-effectiveness-analysis-of-left-atrial-appendage-occlusion-compared-with-pharmacological-strategies-for-stroke-prevention-in-atrial-fibrillation
#8
Vivian Wing-Yan Lee, Ronald Bing-Ching Tsai, Ines Hang-Iao Chow, Bryan Ping-Yen Yan, Mehmet Gungor Kaya, Jai-Wun Park, Yat-Yin Lam
BACKGROUND: Transcatheter left atrial appendage occlusion (LAAO) is a promising therapy for stroke prophylaxis in non-valvular atrial fibrillation (NVAF) but its cost-effectiveness remains understudied. This study evaluated the cost-effectiveness of LAAO for stroke prophylaxis in NVAF. METHODS: A Markov decision analytic model was used to compare the cost-effectiveness of LAAO with 7 pharmacological strategies: aspirin alone, clopidogrel plus aspirin, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban...
2016: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/27549544/left-atrial-appendage-aneurysm
#9
Saeid Hosseini, Arash Hashemi, Sedigheh Saedi, Farshad Jalili, Majid Maleki, Rozita Jalalian, Yousef Rezaei
Left atrial appendage aneurysms (LAAA) are extremely rare. This condition is usually diagnosed incidentally or after the occurrence of thrombotic events or cardiac tachyarrhythmias in the second to fourth decades of life. It can predispose to hazardous adverse events, including atrial fibrillation, myocardial infarction, and systemic thromboembolism. We report a case of LAAA in a 68-year-old woman presenting with atypical chest pain, exertional dyspnea, and episodes of sudden-onset palpitation. Aneurysmectomy with the patient under cardiac arrest with cardiopulmonary bypass was performed...
September 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27530090/acute-sinus-node-dysfunction-after-atrial-ablation-incidence-risk-factors-and-management
#10
Ammar M Killu, Erin A Fender, Abhishek J Deshmukh, Thomas M Munger, Philip Araoz, Peter A Brady, Yong-Mei Cha, Douglas L Packer, Paul A Friedman, Samuel J Asirvatham, Peter A Noseworthy, Siva K Mulpuru
BACKGROUND: Many patients with atrial fibrillation (AF) or atrial flutter (Aflutter) have concomitant sinus node dysfunction (SND). Ablation may result in injury to the sinus node complex or its blood supply resulting in sinus arrest and need for temporary pacing. We sought to characterize patients who develop acute SND (ASND) during/immediately after AF/Aflutter ablation. METHODS: We performed a retrospective analysis of AF/Aflutter ablation patients between January 1, 2010 and February 28, 2015 to characterize those who required temporary pacemaker (TPM) implantation due to ASND (sinus arrest, sinus bradycardia <40 beats/min, or junctional rhythm with hemodynamic compromise) following atrial ablation...
October 2016: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/27443378/incomplete-closure-of-the-left-atrial-appendage-implication-and-management
#11
REVIEW
Arash Aryana, André d'Avila
Incomplete left atrial appendage closure (LAAC) occurs in ∼30-40 % of cases following both surgical and percutaneous closure methods. Incomplete surgical LAAC may further be classified as incompletely surgically ligated LAA (ISLL) or LAA stump. ISLL is associated with a significantly increased risk of thrombus formation/thromboembolism. Moreover, this risk is highest in the absence of oral anticoagulation (OAC) and inversely correlates with the size of the ISLL neck. Not only routine screening for ISLL seems critical, but also long-term OAC should strongly be considered in this high-risk cohort...
September 2016: Current Cardiology Reports
https://www.readbyqxmd.com/read/27430553/atrial-switch-procedure-in-children-more-than-5-years-of-age-mid-term-results
#12
Sachin Talwar, Manikala Vinod Kumar, Amolkumar Bhoje, Shiv Kumar Choudhary, Shyam Sunder Kothari, Rajnish Juneja, Anita Saxena, Balram Airan
OBJECTIVES: In developing countries, where patients present late, the atrial switch operation is still a preferred palliation for d-transposition of great arteries (d-TGA). In this report, we present our experience in patients with d-TGA who were 5 years of age or older. METHODS: Twenty-seven patients underwent an atrial switch procedure between January 2004 and December 2014. The standard technique consisted of a combination of the Senning and Mustard's repair with Schumacker's in situ modification for construction of the pulmonary venous baffle...
November 2016: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/27303240/primary-cardiac-sarcoidosis-with-syncope-and-refractory-atrial-arrhythmia-a-case-report-and-review-of-the-literature
#13
Manoj Thangam, Sriram Nathan, Biswajit Kar, Marija Petrovic, Manish Patel, Pranav Loyalka, L Maximilian Buja, Igor D Gregoric
We discuss the case of a 38-year-old black man who presented at our hospital with his first episode of syncope, recently developed atrial arrhythmias refractory to pharmacologic therapy, and a left atrial thrombus. He was diagnosed with primary cardiac sarcoidosis characterized by predominant involvement of the epicardium that caused atrial fibrillation and atrial flutter. Histologic analysis of his epicardial lesions yielded a diagnosis of sarcoidosis. This patient's atrial arrhythmia was successfully treated with a hybrid operation that involved resection of his atrial appendage, an Epicor maze procedure, and radiofrequency ablation during a catheter-based electrophysiologic study...
June 2016: Texas Heart Institute Journal
https://www.readbyqxmd.com/read/27249551/left-atrial-strain-a-new-predictor-of-thrombotic-risk-and-successful-electrical-cardioversion
#14
Cátia Costa, Teresa González-Alujas, Filipa Valente, Carlos Aranda, José Rodríguez-Palomares, Laura Gutierrez, Giuliana Maldonado, Laura Galian, Gisela Teixidó, Artur Evangelista
BACKGROUND: Left atrial deformation (LAD) parameters are new markers of atrial structural remodelling that seem to be affected in atrial fibrillation (AF) and atrial flutter (AFL). This study aimed to determine whether LAD can identify patients with a higher risk of thrombosis and unsuccessful electrical cardioversion (ECV). METHODS: Retrospective study including 56 patients with AF or AFL undergoing ECV, with previous transthoracic (TTE) and transoesophageal echocardiography (TEE) studies...
June 2016: Echo Research and Practice
https://www.readbyqxmd.com/read/27225288/initial-experience-with-high-risk-patients-excluded-from-clinical-trials-safety-of-short-term-anticoagulation-after-left-atrial-appendage-closure-device
#15
Amr F Barakat, Ayman A Hussein, Walid I Saliba, Mohammed Bassiouny, Khaldoun Tarakji, Mohamed Kanj, Wael Jaber, L Leonardo Rodriguez, Richard Grimm, M Shazam Hussain, Andrew Russman, Ken Uchino, Dolora Wisco, Peter Rasmussen, Mark Bain, John Vargo, Gregory Zuccaro, David Gottesman, Bruce D Lindsay, Oussama M Wazni
BACKGROUND: The implantation of left atrial appendage closure device (WATCHMAN, Boston Scientific, Natick, MA) is an alternative option to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation. Patients require short-term OAC after implantation to avoid device thrombosis. The 2 clinical trials that assessed this device excluded patients thought not to be candidates for OAC. As such, little is known about the safety of this strategy in patients with previous major bleeding events...
June 2016: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/27198686/clinical-implications-of-leaks-following-left-atrial-appendage-ligation-with%C3%A2-the%C3%A2-lariat-device
#16
Carola Gianni, Luigi Di Biase, Chintan Trivedi, Sanghamitra Mohanty, Yalçın Gökoğlan, Mahmut F Güneş, Rong Bai, Amin Al-Ahmad, J David Burkhardt, Rodney P Horton, Andrew K Krumerman, Eugen C Palma, Miguel Valderrábano, Douglas Gibson, Matthew J Price, Andrea Natale
OBJECTIVES: The aim of this study was to evaluate the incidence and clinical implications of leaks (acute incomplete occlusion, early and late reopenings) following LAA ligation with the LARIAT device. BACKGROUND: Percutaneous LAA ligation with the LARIAT device may represent an alternative for stroke prevention in high-risk patients with atrial fibrillation with contraindications to oral anticoagulation. METHODS: This was a retrospective, multicenter study of 98 consecutive patients undergoing successful LAA ligation with the LARIAT device...
May 23, 2016: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27122600/the-left-atrial-appendage-from-embryology-to-prevention-of-thromboembolism
#17
Giuseppe Patti, Vittorio Pengo, Rossella Marcucci, Plinio Cirillo, Giulia Renda, Francesca Santilli, Paolo Calabrò, Alberto Ranieri De Caterina, Ilaria Cavallari, Elisabetta Ricottini, Vito Maurizio Parato, Giacomo Zoppellaro, Giuseppe Di Gioia, Pietro Sedati, Vincenzo Cicchitti, Giovanni Davì, Enrica Golia, Ivana Pariggiano, Paola Simeone, Rosanna Abbate, Domenico Prisco, Marco Zimarino, Francesco Sofi, Felicita Andreotti, Raffaele De Caterina
The left atrial appendage (LAA) is the main source of thromboembolism in patients with non-valvular atrial fibrillation (AF). As such, the LAA can be the target of specific occluding device therapies. Optimal management of patients with AF includes a comprehensive knowledge of the many aspects related to LAA structure and thrombosis. Here we provide baseline notions on the anatomy and function of the LAA, and then focus on current imaging tools for the identification of anatomical varieties. We also describe pathogenetic mechanisms of LAA thrombosis in AF patients, and examine the available evidence on treatment strategies for LAA thrombosis, including the use of non-vitamin K antagonist oral anticoagulants and interventional approaches...
April 26, 2016: European Heart Journal
https://www.readbyqxmd.com/read/27081446/heart-within-a-heart
#18
Tarun Jain, Jainil Shah, Sunay Shah, Shalini Modi
Device based closure of the left atrial appendage (LAA) has emerged as a viable approach for stroke prevention in atrial fibrillation (AF) patients with contraindications to chronic oral anticoagulation. One of the most feared complications is device related thrombus formation. We present a 66-year-old male with chronic AF who developed a life-threatening intracranial bleed on oral anti-coagulation. He subsequently underwent LAA closure using an Amplatzer muscular ventricular septal defect closure device for stroke prevention...
March 2016: Journal of Cardiovascular Ultrasound
https://www.readbyqxmd.com/read/27016474/left-atrial-appendage-morphology-assessment-for-risk-stratification-of-embolic-stroke-in-patients-with-atrial-fibrillation-a-meta-analysis
#19
Florentino Lupercio, Juan Carlos Ruiz, David F Briceno, Jorge Romero, Pedro A Villablanca, Cecilia Berardi, Robert Faillace, Andrew Krumerman, John D Fisher, Kevin Ferrick, Mario Garcia, Andrea Natale, Luigi Di Biase
BACKGROUND: Thromboembolic event (TE) risk stratification is performed by using CHA2DS2VASc score. It has been suggested that left atrial appendage (LAA) morphology independently influences TE risk in patients with nonvalvular atrial fibrillation. LAA morphology has been classified into 4 types: chicken wing, cauliflower, windsock, and cactus. OBJECTIVE: The purpose of this study was to determine TE risk for each LAA morphology in patients with atrial fibrillation with low to intermediate TE risk...
July 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/26991684/tailored-treatment-strategies-a-new-approach-for-modern-management-of-atrial-fibrillation
#20
REVIEW
I C Van Gelder, A H Hobbelt, E G Marcos, U Schotten, R Cappato, T Lewalter, J Schwieler, M Rienstra, G Boriani
Atrial fibrillation (AF) is not benign. Cardiovascular diseases and risk factors differ importantly amongst patients. Careful phenotyping with the aim to start tailored therapy may improve outcome and quality of life. Furthermore, structural remodelling plays an important role in initiation and progression of AF. Therapies that interfere in the remodelling processes are promising because they may modify the atrial substrate. However, success is still limited probably due to variations in the underlying substrate in individual patients...
May 2016: Journal of Internal Medicine
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