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left atrial appendage management

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https://www.readbyqxmd.com/read/28795688/interventional-and-surgical-occlusion-of-the-left-atrial-appendage
#1
REVIEW
Etem Caliskan, James L Cox, David R Holmes, Bernhard Meier, Dhanunjaya R Lakkireddy, Volkmar Falk, Sacha P Salzberg, Maximilian Y Emmert
With a steadily increasing prevalence, atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and an independent risk factor for stroke caused by thromboembolic events. The left atrial appendage (LAA) is the primary source of thromboemboli in patients with nonvalvular AF who have a stroke. Novel strategies (such as mechanical and nonpharmacological intervention) targeting the LAA in patients with AF for stroke prevention have become a major focus during the past decade. Some devices for percutaneous LAA occlusion are supported by robust clinical data obtained from randomized trials or large registries, and are a valid alternative to pharmacological stroke prevention...
August 10, 2017: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/28758758/-thoracoscopic-epicardial-ablation-of-atrial-fibrillation-using-the-cobra-fusion-system-as-the-first-part-of-hybrid-ablation
#2
P Budera, P Osmančík, D Talavera, R Fojt, A Kraupnerová, J Žďárská, T Vaněk, Z Straka
INTRODUCTION: Treatment of persistent and long-standing persistent atrial fibrillation is not successfully managed by methods of catheter ablation or pharmacotherapy. Hybrid ablation (i.e. combination of minimally invasive surgical ablation, followed by electrophysiological assessment and subsequent endocardial catheter ablation to complete the entire intended procedure) presents an ever more used and very promising treatment method. METHOD: Patients underwent thoracoscopic ablation of pulmonary veins and posterior wall of the left atrium (the box-lesion) with use of the COBRA Fusion catheter; thoracoscopic occlusion of the left atrial appendage using the AtriClip system was also done in later patients...
2017: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
https://www.readbyqxmd.com/read/28754397/contemporary-atrial-fibrillation-management-a-comparison-of-the-current-aha-acc-hrs-ccs-and-esc-guidelines
#3
REVIEW
Jason G Andrade, Laurent Macle, Stanley Nattel, Atul Verma, John Cairns
In this article we compare and contrast the current recommendations, and highlight the important differences, in the American College of Cardiology/American Heart Association/Heart Rhythm Society, European Society of Cardiology, and Canadian Cardiovascular Society atrial fibrillation (AF) guidelines. Although many of the recommendations of the various societies are similar, there are important differences in the methodologies underlying their development and the specific content. Specifically, key differences can be observed in: (1) the definition of nonvalvular AF, which subsequently affects anticoagulation choices and candidacy for non-vitamin K antagonist oral anticoagulants; (2) the symptom score used to guide management decisions and longitudinal patient profiling; (3) the stroke risk stratification algorithm used to determine indications for oral anticoagulant therapy; (4) the role of acetylsalicylic acid in stroke prevention in AF; (5) the antithrombotic regimens used in the context of coronary artery disease, acute coronary syndromes, and percutaneous coronary intervention; (6) the rate control target and medications recommended to achieve the target; and (7) the role of "first-line" catheter ablation, open surgical ablation, and left atrial appendage exclusion...
August 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28736561/recent-advances-in-stroke-prevention-in-patients-with-atrial-fibrillation-and-end-stage-renal-disease
#4
REVIEW
Federico Ronco, Patrizio Mazzone, Leila Hosseinian, Simonetta Genovesi
BACKGROUND: Chronic kidney disease (CKD) is associated with a high prevalence of atrial fibrillation (AF), but in this population the risk/benefit ratio of anticoagulant therapy with vitamin K antagonists (VKA) for thromboprophylaxis is uncertain. SUMMARY: In end-stage renal disease (ESRD) patients undergoing hemodialysis, VKA seem less effective in stroke prevention than in the general population, with an increased risk of major bleeding. Recently, novel oral anticoagulant agents (NOACs) have proven to be effective for stroke prevention in AF and have demonstrated an improved safety profile compared to VKA...
June 2017: Cardiorenal Medicine
https://www.readbyqxmd.com/read/28691914/residual-leaks-following-percutaneous-left-atrial-appendage-occlusion-assessment-and-management-implications
#5
Claire E Raphael, Paul A Friedman, Jacqueline Saw, Sorin V Pislaru, Thomas M Munger, David R Holmes
Left atrial appendage (LAA) closure for stroke prevention in the setting of non valvular atrial fibrillation is an alternative to oral anticoagulation in patients with increased bleeding risk. It allows similar reduction in thromboembolic events, in particular stroke, compared to warfarin. A common clinical dilemma is the management of patients with peri-device leak after LAA occlusion. This has been documented in both percutaneous as well as with surgical approaches. The specific definitions of leak severity, and the longer term clinical implications are poorly understood...
July 11, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28680466/atrial-fibrillation-with-a-structurally-normal-heart-in-pregnancy-an-international-survey-on-current-practice
#6
Annabelle Cumyn, Nadine Sauvé, Évelyne Rey
BACKGROUND: Little evidence exists for the optimal management of atrial fibrillation with a structurally normal heart in pregnancy. METHODS: A survey was sent to members of two associations to obtain input on optimal management of atrial fibrillation in pregnancy. The survey presented four cases with respect to (1) baseline investigations; (2) rate versus rhythm control; (3) chemical versus electrical cardioversion; and (4) anticoagulation. RESULTS: Sixty-one responders from 11 countries participated...
June 2017: Obstetric Medicine
https://www.readbyqxmd.com/read/28661896/vitamin-k-antagonists-versus-novel-oral-anticoagulants-for-elective-electrical-cardioversion-of-atrial-fibrillation
#7
Diana Ţînţ, Antoniu O Petriş, Ioana Pop, Rimma Melnic, Andreea-Mihaela Ignat, Liliana M Rogozea
BACKGROUND: The management strategy for patients with atrial fibrillation (AF) is often very complex, electrical cardioversion (EC) being often used to restore sinus rhythm in those patients. The increased risk of thromboembolic complications was lowered using anticoagulation therapy. Usually, the anticoagulation was achieved using vitamin K antagonists (VKAs), but over the last years we witnessed a wide implementation of the novel oral anticoagulants (NOACs). STUDY QUESTION: Study question was to compare the efficacy of NOACs versus VKAs in patients undergoing elective EC for persistent AF, by assessing the presence of left atrial spontaneous contrast and left atrial thrombi (LACS), as well as the occurrence of the thromboembolic events in the first month after the procedure...
April 26, 2017: American Journal of Therapeutics
https://www.readbyqxmd.com/read/28644155/transvenous-before-surgical-hybrid-procedure
#8
Joseph J Tiano, Robert Drennan, John Novella, Rafael Squiteri, Malcolm Robinson, Albert DiMeo, Lindsey Scierka, Paul LeLorier
BACKGROUND: Historically, persistent atrial fibrillation (PeAF) and long standing persistent atrial fibrillation (LSPeAF) have demonstrated limited clinical success despite hybrid approaches. OBJECTIVE: We describe our experience with the endocardial-before-epicardial approach defined by a comprehensive endovascular approach preceding and guiding the epicardial approach which includes an extensive posterior wall ablation. METHODS: 40 patients were followed over a 12 month period...
May 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28639873/anesthetic-management-of-patients-undergoing-percutaneous-endocardial-and-epicardial-left-atrial-appendage-occlusion
#9
Zeena Husain, Payam Safavi-Naeini, Abdi Rasekh, Mehdi Razavi, Charles D Collard, James M Anton, Daniel A Tolpin
Atrial fibrillation is the most common cardiac arrhythmia in adults affecting almost 6 million adults in the United States. The 2 most common comorbidities associated with atrial fibrillation are heart failure and thromboembolic events. Heart failure symptoms may be treated with rate control, antiarrhythmic medications or by catheter ablation. Unfortunately, despite optimal medical management, thromboembolic events still occur. Recently, there has been a great deal of interest and innovation in finding an alternative to chronic anticoagulation...
June 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28626989/electrical-isolation-of-the-left-atrial-appendage-by-maze-like-catheter-substrate-modification-a-reproducible-strategy-for-pulmonary-vein-isolation-non-responders
#10
Stefano Bordignon, Laura Perrotta, Daniela Dugo, Fabrizio Bologna, Takahiko Nagase, Alexander Fuernkranz, Kr Julian Chun, Boris Schmidt
INTRODUCTION: The ablation strategy for atrial fibrillation (AF) despite pulmonary vein isolation (PVI) is controversial. Left atrial appendage isolation (LAAI) may contribute to improve outcome. We describe an ablation approach ("Maze-like"-LAAI) that (1) modifies the underlying LA substrate by linear ablation (2) eliminates the LAA as a putative AF trigger site and (3) incorporates an unambiguous procedural endpoint. The role of LAA closure (LAAC) after LAAI was investigated. METHODS: Patients with atrial tachyarrhythmias non-responsive to PVI underwent a LAAI ablation procedure...
June 19, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28534025/atrial-fibrillation-dynamics-and-ionic-block-effects-in-six-heterogeneous-human-3d-virtual-atria-with-distinct-repolarization-dynamics
#11
Carlos Sánchez, Alfonso Bueno-Orovio, Esther Pueyo, Blanca Rodríguez
Atrial fibrillation (AF) usually manifests as reentrant circuits propagating through the whole atria creating chaotic activation patterns. Little is yet known about how differences in electrophysiological and ionic properties between patients modulate reentrant patterns in AF. The goal of this study is to quantify how variability in action potential duration (APD) at different stages of repolarization determines AF dynamics and their modulation by ionic block using a set of virtual whole-atria human models...
2017: Frontiers in Bioengineering and Biotechnology
https://www.readbyqxmd.com/read/28496929/management-of-patients-with-atrial-fibrillation-focus-on-treatment-options
#12
REVIEW
Pawel Matusik, Jacek Lelakowski, Barbara Malecka, Jacek Bednarek, Remigiusz Noworolski
Atrial fibrillation (AF) is leading cardiac arrhythmia with important clinical implications. Its diagnosis is usually made on the basis on 12-lead ECG or 24-hour Holter monitoring. More and more clinical evidence supports diagnostic use of cardiac event recorders and cardiovascular implantable electronic devices (CIED). Treatment options in patients with atrial fibrillation are extensive and are based on chosen rhythm and/or rate control strategy. The use and selected contraindications to AF related pharmacotherapy, including anticoagulants are shown...
October 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/28459917/minimally-invasive-closure-of-the-left-atrial-appendage-a-non-pharmacologic-approach-to-prevention-of-stroke-in-patients-with-atrial-fibrillation
#13
Brian D McCauley, Antony F Chu
Atrial Fibrillation's (AF) role in the pathogenesis of thromboembolic stroke has been well established, with estimates from trials of approximately 15-20% of all strokes in the U.S. Research shows more than 90% of atrial thrombi originate from the left atrial appendage (LAA). Traditionally, oral anticoagulants (OACs) have been the keystone of management for AF in reducing the risk of thromboembolic stroke. However, OACs also pose a non-negligible risk of bleeding with between 30-50% of eligible patients not receiving OACs due to absolute contraindications or perceived increased bleeding risk...
May 1, 2017: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/28439617/-stroke-prophylaxis-in-atrial-fibrillation-when-how-and-for-whom
#14
T Maurer, C Sohns
In patients suffering from atrial fibrillation (AF), modern antithrombotic therapy and anticoagulation strategies should be individualized based on shared decision making including patient preferences and the absolute and relative risks of stroke and bleeding. Estimation of the individual risk for stroke is still based on the CHA2DS2-VASc score. Based on the most recent guidelines for the management of AF, oral anticoagulation therapy should be considered for men with a CHA2DS2-VASc score ≥1 and women with a score ≥2, balancing the expected stroke reduction, risk of bleeding and patient preference...
April 24, 2017: Herz
https://www.readbyqxmd.com/read/28433223/risk-of-intraatrial-thrombi-after-thoracoscopic-ablation-in-absence-of-heparin-and-appendage-closure
#15
Petr Budera, Pavel Osmancik, Dalibor Herman, David Talavera, Robert Petr, Zbynek Straka
BACKGROUND: Catheter and surgical ablation of atrial fibrillation (AF) can be associated with a risk of thromboembolic events. The goal of this study was to assess optimal anticoagulation management during thoracoscopic ablation of AF. METHODS: Fifty-two patients with persistent or long-standing persistent AF underwent hybrid ablation consisting of thoracoscopic ablation followed by electrophysiologic (EP) evaluation and consecutive ablation if indicated. The thoracoscopic ablation was performed using three different anticoagulation protocols: (1) without periprocedural heparin and without occlusion of the left atrial appendage; (2) with periprocedural heparin but without left atrial appendage occlusion; and (3) with periprocedural heparin and left atrial appendage occlusion...
April 19, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28432672/para-atrial-non-acute-mediastinal-hematoma-after-left-atrial-maze-procedure-mimicking-tumor-in-a-patient-with-treated-melanoma
#16
G Schaiberger, D Pucar, V Patel, B Bateson, H Williams, W Bates
INTRODUCTION: The Cox Maze III procedure is considered the gold standard open surgical procedure for management of atrial fibrillation. This article outlines a unique case of a para-atrial mediastinal hematoma following a bilateral thoracoscopic left atrial Maze procedure mimicking malignancy. REPORT: A 60-year-old male, with past history of melanoma, underwent bilateral thoracoscopic left atrial mini maze procedure with radiofrequency energy and exclusion of the left atrial appendage...
April 21, 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/28401455/what-is-the-appropriate-lesion-set-for-ablation-in-patients-with-persistent-atrial-fibrillation
#17
REVIEW
Jorge Romero, Carola Gianni, Andrea Natale, Luigi Di Biase
Special attention must be paid to detect, diagnose, and optimize management of reversible or treatable causes of long-standing persistent atrial fibrillation (LSPAF) such as obesity, obstructive sleep apnea (OSA), hypertension, hypo or hyperthyroidism, inflammatory and infectious diseases, and stress. Though, we strongly believe that the role of the pulmonary veins (PVs) is more pronounced in paroxysmal atrial fibrillation (AF) than in persistent AF, performing an adequate pulmonary vein isolation is still key in LSPAF...
May 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28390428/rivaroxaban-as-an-effective-alternative-to-warfarin-in-a-patient-with-atrial-fibrillation-thrombophilia-and-left-atrial-appendage-thrombus-a-case-report
#18
Michele Scarano, Matteo Casale, Cesare Mantini, Egidio Imbalzano, Cristiana Consorti, Daniela Clemente, Giuseppe Dattilo
BACKGROUND: Atrial fibrillation is the most common cardiac arrhythmia. It is responsible for up to 20% of all ischemic strokes. Rate control and anticoagulation are crucial for atrial fibrillation management and stroke prevention. CASE PRESENTATION: We present the case of an 84-year-old Italian woman with a left atrial appendage thrombus that developed despite her use of anticoagulant therapy with warfarin for a previous pulmonary embolism. She had atrial fibrillation and heterozygosity for both factor V Leiden and methylenetetrahydrofolate reductase C677T mutation, thus creating resistance to activated protein C...
April 9, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28381122/argon-exposure-induces-postconditioning-in-myocardial-ischemia-reperfusion
#19
Sandrine Lemoine, Katrien Blanchart, Mathieu Souplis, Adrien Lemaitre, Damien Legallois, Laurent Coulbault, Christophe Simard, Stéphane Allouche, Jacques H Abraini, Jean-Luc Hanouz, René Rouet, Laurent Sallé, Romain Guinamard, Alain Manrique
BACKGROUND AND PURPOSE: Cardioprotection against ischemia-reperfusion (I/R) damages remains a major concern during prehospital management of acute myocardial infarction. Noble gases have shown beneficial effects in preconditioning studies. Because emergency proceedings in the context of myocardial infarction require postconditioning strategies, we evaluated the effects of argon in such protocols on mammalian cardiac tissue. EXPERIMENTAL APPROACHES: In rat, cardiac I/R was induced in vivo by transient coronary artery ligature and cardiac functions were evaluated by magnetic resonance imaging...
January 1, 2017: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28302138/congenital-giant-left-atrial-appendage-aneurysm-a-case-report
#20
Yan Chen, Yun Mou, Li-Jun Jiang, Shen-Jiang Hu
BACKGROUND: Congenital left atrial appendage aneurysm (LAAA) is a rare cardiac anomaly with potentially serious complications, including life-threatening systemic thromboembolism, atrial tachyarrhythmia, and cardiac dysfunction. Currently, early surgical intervention is generally recommended to prevent these complications. CASE PRESENTATION: We present a case of congenital giant LAAA in a female patient who successfully completed pregnancy and underwent caesarean section with no obvious complications...
March 16, 2017: Journal of Cardiothoracic Surgery
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