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left atrial appendage management

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https://www.readbyqxmd.com/read/29453694/percutaneous-left-atrial-appendage-occlusion-in-the-prevention-of-stroke-in-atrial-fibrillation-a-systematic-review
#1
REVIEW
Jayson R Baman, Moussa Mansour, E Kevin Heist, David T Huang, Yitschak Biton
Atrial fibrillation is commonly coexistent with heart failure, and the management of the heart failure patient would be incomplete without an appreciation for atrial fibrillation management. There are many complications associated with oral anticoagulation in the prevention of stroke related to atrial fibrillation. In recent years, the advent of several percutaneous left atrial appendage (LAA) occlusion/closure strategies has sought to provide an alternative treatment modality. Here, we systematically review the published literature to investigate the efficacy and safety of percutaneous LAA occlusion/closure devices...
February 17, 2018: Heart Failure Reviews
https://www.readbyqxmd.com/read/29439542/update-on-the-non-pharmacological-management-of-stroke-prevention-in-patients-with-atrial-fibrillation
#2
REVIEW
Aneesh Tolat, Neal Lippman
Non-surgical left atrial appendage occlusion has emerged as an alternative to anticoagulant therapy in the management of stroke risk in patients with atrial fibrillation. This review reports on some of the more common devices that are currently being used to manage patients in this challenging group.
February 12, 2018: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/29411147/atrial-fibrillation-for-the-neurologist-preventing-both-ischemic-and-hemorrhagic-strokes
#3
REVIEW
Elif Gokcal, Marco Pasi, Marc Fisher, M Edip Gurol
PURPOSE OF REVIEW: This review aims to help neurologists managing atrial fibrillation (AF) patients who had an ischemic stroke and/or with intracranial hemorrhage (ICH) markers, therefore at high embolic/hemorrhagic risks. RECENT FINDINGS: Implantable loop recorders have substantially improved the accuracy of AF detection. Recent research yielded a set of powerful neuroimaging markers that can stratify ICH risk. Direct oral anticoagulants (DOAC) are easier to use with a lower ICH risk than warfarin in a general AF population...
February 6, 2018: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/29395705/assessment-and-management-of-the-left-atrial-appendage-thrombus-in-patients-with-nonvalvular-atrial-fibrillation
#4
REVIEW
Yang Zhan, Jacqueline Joza, Mohamed Al Rawahi, Rodrigo S Barbosa, Michelle Samuel, Martin Bernier, Thao Huynh, George Thanassoulis, Vidal Essebag
BACKGROUND: Intracardiac thrombi arising in the left atrial appendage (LAA) are the principal cause of stroke in nonvalvular atrial fibrillation (AF). Predicting the presence of LAA thrombi is of vital importance in stratifying patients that would need further LAA imaging prior to cardioversion or AF ablation. METHODS: We comprehensively searched PubMed from its inception to November 2017 for randomized controlled trials, cohort and case control studies, as well as for case series on LAA thrombi risk factors, imaging, prevention, and anticoagulation management in atrial fibrillation...
December 15, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29348012/coronary-embolus-an-underappreciated-cause-of-acute-coronary-syndromes
#5
REVIEW
Claire E Raphael, John A Heit, Guy S Reeder, Melanie C Bois, Joseph J Maleszewski, R Thomas Tilbury, David R Holmes
Coronary embolism is the underlying cause of 3% of acute coronary syndromes but is often not considered in the differential of acute coronary syndromes. It should be suspected in the case of high thrombus burden despite a relatively normal underlying vessel or recurrent coronary thrombus. Coronary embolism may be direct (from the aortic valve or left atrial appendage), paroxysmal (from the venous circulation through a patent foramen ovale), or iatrogenic (following cardiac intervention). Investigations include transesophageal echocardiography to assess the left atrial appendage and atrial septum and continuous electrocardiographic monitoring to assess for paroxysmal atrial fibrillation...
January 22, 2018: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29289951/cardioembolic-stroke-in-patient-with-transcatheter-occluded-left-atrial-appendage
#6
Umberto Cucchini, Denisa Muraru, Luigi P Badano
A cerebral ischemic event in a patient managed with left atrial appendage (LAA) transcatheter obliteration is illustrated. Transesophageal echocardiography allowed identification and accurate definition of the LAA device leakage.
January 2018: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/29274913/oral-anticoagulation-may-not-be-necessary-for-patients-discharged-in-sinus-rhythm-after-the-cox-maze-iv-procedure
#7
Takashi Murashita, J Scott Rankin, Lawrence M Wei, Harold G Roberts, Mohamad A Alkhouli, Vinay Badhwar
OBJECTIVES: Oral anticoagulants have inherent risks. In the absence of clear evidence, anticoagulant use after surgical ablation for atrial fibrillation remains variable. This study examined patient outcomes with and without oral anticoagulants after successful surgical ablation. METHODS: From October 2011 to April 2016, 239 consecutive patients underwent biatrial Cox Maze IV operations for persistent atrial fibrillation. All patients received endocardial left atrial appendage obliteration...
December 6, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29236953/applications-of-cardiac-computed-tomography-in-electrophysiology-intervention
#8
S Liddy, U Buckley, H K Kok, B Loo, B Glover, G R Dhillon, O Buckley
Cardiac electrophysiology is an evolving specialty that has seen rapid advances in recent years. Concurrently, there has been much progress in the field of cardiac imaging. Electrophysiologists are increasingly requesting cross-sectional imaging in advance of many procedures. Pulmonary vein isolation and left atrial appendage (LAA) occlusion are now an established treatment options for atrial fibrillation. In patients undergoing pulmonary vein isolation, applications of computed tomography (CT) include evaluating the left atrial and pulmonary venous anatomy, excluding LAA thrombus and assessing for pulmonary vein stenosis...
December 9, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/29228158/percutaneous-left-atrial-appendage-occlusion-in-atrial-fibrillation-patients-with-a-contraindication-to-oral-anticoagulation-a-focused-review
#9
Marin Nishimura, Shiv Sab, Ryan R Reeves, Jonathan C Hsu
Stroke is the most feared complication of atrial fibrillation (AF). Although oral anticoagulation with non-vitamin K antagonist and non-vitamin K antagonist oral anticoagulants (NOACs) have been established to significantly reduce risk of stroke, real-world use of these agents are often suboptimal due to concerns for adverse events including bleeding from both patients and clinicians. Particularly in patients with previous serious bleeding, oral anticoagulation may be contraindicated. Left atrial appendage occlusion (LAAO), mechanically targeting the source of most of the thrombi in AF, holds an immense potential as an alternative to OAC in management of stroke prophylaxis...
December 8, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29129259/comparison-of-prevalence-and-management-of-left-atrial-appendage-thrombi-under-old-and-new-anticoagulants-prior-to-left-atrial-catheter-ablation
#10
COMPARATIVE STUDY
Antoine Da Costa, Clarisse Delolme, Jean Baptiste Guichard, Antoine Gerbay, Romain Pierrard, Cécile Romeyer-Bouchard, Karl Isaaz
BACKGROUND: The prevalence and management of left atrial appendage (LAA) thrombi associated with new anticoagulants remain to be elucidated, especially prior to atrial fibrillation (AFib) ablation. This study sought to (1) compare the prevalence of LAA thrombi and/or severe LAA contrast under vitamin K antagonist (VKA) agents and novel oral anticoagulants (NOACs), (2) evaluate the rate of LAA thrombus resolution after anticoagulation modification, and (3) determine the predictive factors of LAA thrombi and severe LAA contrast in patients prior to LA AFib ablation...
November 2017: American Heart Journal
https://www.readbyqxmd.com/read/29128265/atrial-flutter-has-less-left-atrial-spontaneous-contrast-and-higher-left-atrial-appendage-emptying-velocity-compared-with-atrial-fibrillation
#11
Jennifer J Huang, Sridhar Reddy, Tam H Truong, Prakash Suryanarayana, Joseph S Alpert
BACKGROUND: The risk of stroke and thromboembolism in atrial fibrillation is established. There are clear guidelines in anticoagulation management of patient's with atrial fibrillation, however, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography (TEE); thereby possibly leading to a lower stroke risk...
November 8, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29121173/managing-the-left-atrial-appendage
#12
Maximilian Y Emmert
No abstract text is available yet for this article.
May 21, 2017: European Heart Journal
https://www.readbyqxmd.com/read/29101545/-recent-and-upcoming-randomized-trials-for-left-atrial-appendage-occlusion-need-for-a-definite-assessment-of-the-situation
#13
REVIEW
Carsten Skurk, Johannes Jakob Hartung, Ulf Landmesser
Atrial fibrillation (AF) is the most common arrhythmia affecting more than 1.6 million patients in Germany. Based on demographic developments, an the number is expected to increase. Embolic strokes in AF patients are particularly severe, and individualized new oral anticoagulant (NOAC) therapy reduces the incidence of stroke in these patients by approximately 70%. Besides vitamin K antagonists, the NOACs rivaroxaban, dabigatran, apixaban, and edoxaban have been introduced into clinical practice; however, major bleeding still occurs at a rate of 2-3% per year...
November 3, 2017: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/29025548/percutaneous-therapy-in-pericardial-diseases
#14
REVIEW
Bernhard Maisch, Arsen D Ristić, Sabine Pankuweit, Petar Seferovic
Interventional procedures for pericardial diseases include pericardiocentesis, drainage of pericardial effusion, intrapericardial therapy, and percutaneous balloon pericardiotomy or percutaneous pericardiostomy. Echocardiographic and fluoroscopic guidance have greatly increased safety and feasibility. Several devices for pericardiocentesis have been tested (PerDucer, PeriAttacher, visual puncture systems, Grasper, Scissors, and Reverse slitter), mainly to facilitate access to the pericardium in the absence of effusion for epicardial ablations or left atrial appendage ligation...
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29016910/left-atrial-appendage-occluder-implantation-in-europe-indications-and-anticoagulation-post-implantation-results-of-the-european-heart-rhythm-association-survey
#15
Roland Richard Tilz, Tatjana Potpara, Jian Chen, Dan Dobreanu, Torben Bjerregaard Larsen, Kristina Herman Haugaa, Nikolaos Dagres
The aim of this EP Wire survey was to assess the indications and anticoagulation strategies post-left atrial appendage occluder (LAAO) implantation for stroke prevention in patients with non-valvular atrial fibrillation in Europe. A total of 33 centres in 13 European countries completed the survey. All centres were members of the European Heart Rhythm Association Electrophysiology Research Network. Left atrial appendage occluder procedures were performed by electrophysiologists in 52% of the centres and by interventional cardiologists in the remaining centres...
October 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29016766/temporal-pattern-episode-duration-based-classification-of-atrial-fibrillation-as-paroxysmal-vs-persistent-is-it-time-to-develop-a-more-integrated-prognostic-score-to-optimize-management
#16
Matthew Hammond-Haley, Rui Providência, Pier D Lambiase
Atrial fibrillation (AF) is a clinically heterogeneous arrhythmia that is currently classified according to the variety of temporal rhythm based manifestations observed clinically, including 'first detected episode', 'paroxysmal', 'persistent', or 'permanent' AF. Despite being widely adopted by the most recent consensus guidelines, the utility of this classification system to stratify patients into distinct and clinically useful groups that have different outcomes including mortality, morbidity, specific cardiovascular outcomes, and quality of life (QoL), remains questionable...
July 11, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28942610/impact-of-acute-left-ventricular-apical-thrombus-on-cardioversion-for-atrial-fibrillation
#17
Vaibhav R Vaidya, Suartcha Prueksaritanond, John P Bois, Abhinav Nadipalli, Daniel D Borgeson, Rowlens M Melduni
Among patients undergoing cardioversion for atrial fibrillation, the presence of left ventricular thrombus is a relatively uncommon and challenging clinical dilemma. While left atrial appendage thrombus is a contraindication to cardioversion, there is paucity of data regarding the safety of cardioversion in with the presence of left ventricular apical thrombus. Also, thrombus characteristics such as protrusion and mobility on echocardiography are known risk factors for systemic embolism. In this article, we present a case highlighting the management of atrial fibrillation in the setting of left ventricular dysfunction, acute heart failure, and echocardiographic evidence of acute left ventricular apical thrombus...
November 2017: Echocardiography
https://www.readbyqxmd.com/read/28928613/clarifying-the-anatomy-and-physiology-of-totally-anomalous-systemic-venous-connection
#18
REVIEW
Saurabh Kumar Gupta, Rajnish Juneja, Robert H Anderson, Gurpreet S Gulati, Velayoudam Devagorou
The description of totally anomalous systemic venous connection is limited to case reports. In this review, we seek to clarify anatomic, physiologic, and hemodynamic aspects of this extremely rare anomaly. We also present findings of two patients in whom connection of all the systemic veins was anomalous. In the first patient, with usual atrial arrangement, all systemic veins, including the coronary sinus, were connected anomalously to the morphologically left atrium. Limited left-to-right shunt across an atrial septal defect provided the only source of blood flow to the lungs...
September 2017: Annals of Pediatric Cardiology
https://www.readbyqxmd.com/read/28826990/managing-the-left-atrial-appendage-in-atrial-fibrillation-current-state-of-the-art
#19
REVIEW
Waqaar Khawar, Nathan Smith, Saqib Masroor
BACKGROUND: Patients with atrial fibrillation are at increased risk for thromboembolic stroke originating predominantly in the left atrial appendage. To reduce the risk, the standard of care is anticoagulation. In addition, several devices for exclusion of the left atrial appendage have been developed. METHODS: PubMed was searched for articles relevant to left atrial appendage management. The resulting articles were reviewed as were relevant articles in their bibliographies...
December 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28795688/interventional-and-surgical-occlusion-of-the-left-atrial-appendage
#20
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
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