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https://www.readbyqxmd.com/read/29339165/safety-and-efficacy-of-transcatheter-left-atrial-appendage-closure-for-stroke-prevention-in-patients-with-atrial-fibrillation
#1
REVIEW
Matthew J Price
Atrial fibrillation (AF) is associated with a substantial risk of thromboembolic stroke. Although long-term treatment with warfarin or the non-vitamin K oral anticoagulants can reduce this risk, such therapy is underutilized, and safe and consistent long-term treatment can be challenging. Transcatheter left atrial appendage (LAA) closure is an emerging alternative to long-term oral anticoagulation. Long-term follow-up of randomized clinical trials demonstrate that Watchman LAA closure provides significant reductions in hemorrhagic stroke, cardiovascular death, and all-cause mortality compared with continued warfarin therapy...
January 12, 2018: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/29313819/real-world-safety-and-efficacy-of-watchman-laa-closure-at-one-year-in-patients-on-dual-antiplatelet-therapy-results-of-the-dapt-subgroup-from-the-ewolution-all-comers-study
#2
Martin W Bergmann, Hüseyin Ince, Stephan Kische, Thomas Schmitz, Felix Meincke, Boris Schmidt, David Foley, Timothy R Betts, Marek Grygier, Alexey V Protopopov, Kenneth M Stein, Lucas V A Boersma
AIMS: The study aims to confirm efficacy and safety of WATCHMAN LAA closure in AF patients unsuitable for oral anticoagulation. METHODS AND RESULTS: The EWOLUTION registry prospectively collects all clinical data on 1005 European patients implanted with a WATCHMAN device. Following the procedure, 605 patients (60.2%) received dual antiplatelet therapy according to the local standard; DAPT was discontinued in 85% of pts within 1 year. CHA2DS2-VASc and HAS-BLED scores were 4...
January 9, 2018: EuroIntervention
https://www.readbyqxmd.com/read/29297907/-combined-left-atrial-appendage-percutaneous-closure-and-atrial-fibrillation-ablation-a-single-center-experience
#3
Elisa Pelissero, Marco Giuggia, Maria Chiara Todaro, Giuseppe Trapani, Benedetta Giordano, Gaetano Senatore
BACKGROUND: We evaluated long-term safety and efficacy of concomitant left atrial appendage (LAA) closure and atrial fibrillation (AF) ablation. METHODS: From February 2013 to June 2017, all patients referred for AF ablation and LAA closure (group 1) were enrolled in the study and compared with a matched control group undergoing AF ablation only (group 2). Pulmonary vein isolation was achieved in all cases with radiofrequency or cryoballoon. LAA was occluded with Watchman or Amplatzer Cardiac Plug or Amulet (ACP) devices...
December 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/29233088/left-atrial-enlargement-and-clinical-considerations-in-patients-with-or-without-a-residual-interatrial-shunt-after-closure-of-the-left-atrial-appendage-with-the-watchman%C3%A2-device
#4
Blerim Luani, Thomas Groscheck, Conrad Genz, Ivan Tanev, Thomas Rauwolf, Joerg Herold, Senad Medunjanin, Alexander Schmeisser, Rüdiger C Braun-Dullaeus
BACKGROUND: Interventional closure of the left atrial appendage (LAA) in patients with non-valvular atrial fibrillation, high thromboembolic and bleeding risk or bleeding history is an alternative therapeutic strategy to oral anticoagulation. It is not known if the exclusion of the LAA from the blood circulation affects the left atrial volume (LAV) and consequently its prognostic value or the circulatory performance of the heart in humans. METHODS: We aimed to prospectively assess potential changes in baseline LAV, left ventricular ejection fraction (LVEF), NT-proBNP-level and the covered distance in the 6-min walk-test 6 weeks and 6 months after LAA closure with the WATCHMAN™ device...
December 12, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/29223726/computed-tomography-measurement-of-the-left-atrial-appendage-for-optimal-sizing-of-the-watchman-device
#5
Bo Xu, Jorge Betancor, Kimi Sato, Serge Harb, Karim Abdur Rehman, Kunal Patel, Arnav Kumar, Paul C Cremer, Wael Jaber, L Leonardo Rodriguez, Paul Schoenhagen, Oussama Wazni
INTRODUCTION: Percutaneous left atrial appendage (LAA) occlusion is an emerging treatment option for patients with non-valvular atrial fibrillation who cannot tolerate oral anticoagulation. The Watchman device (Boston Scientific Corporation, Natick, MA, USA) is deployed at the ostium of the LAA, and an appropriately sized device is critical for successful occlusion. However, standardized imaging protocols for device sizing have not been established. OBJECTIVES: We investigated the clinical utility of a standardized imaging protocol, with pre-procedural multi-detector cardiac computed tomography (MDCT), and intra-procedural transesophageal echocardiography (TEE), for Watchman device sizing...
December 5, 2017: Journal of Cardiovascular Computed Tomography
https://www.readbyqxmd.com/read/29222738/ct-based-3d-printing-is-superior-to-transesophageal-echocardiography-for-pre-procedure-planning-in-left-atrial-appendage-device-closure
#6
Edinrin Obasare, Sumeet K Mainigi, D Lynn Morris, Leandro Slipczuk, Igor Goykhman, Evan Friend, Mary Rodriguez Ziccardi, Gregg S Pressman
Accurate assessment of the left atrial appendage (LAA) is important for pre-procedure planning when utilizing device closure for stroke reduction. Sizing is traditionally done with transesophageal echocardiography (TEE) but this is not always precise. Three-dimensional (3D) printing of the LAA may be more accurate. 24 patients underwent Watchman device (WD) implantation (71 ± 11 years, 42% female). All had complete 2-dimensional TEE. Fourteen also had cardiac computed tomography (CCT) with 3D printing to produce a latex model of the LAA for pre-procedure planning...
December 8, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/29194654/safety-and-efficacy-analysis-of-one-stop-intervention-for-treating-nonvalvular-atrial-fibrillation
#7
Hongde Hu, Kaijun Cui, Jian Jiang, Hua Fu, Rui Zeng
BACKGROUND: Nonvalvular atrial fibrillation (AF) is a common arrhythmia. The treatment strategy for AF mainly includes controlling symptoms and decreasing the rate of complications. Our study aimed to evaluate the safety and efficacy of combination treatment of catheter ablation and left atrial appendage (LAA) closure (one-stop intervention) in patients with nonvalvular AF. METHODS AND RESULTS: Thirty-four patients with symptomatic AF (mean CHA2 DS2 -VASc score 4...
November 30, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29181735/-oral-anticoagulation-and-platelet-inhibition-after-atrial-appendage-occlusion
#8
REVIEW
Martin W Bergmann, Carsten W Israel
In Europe left atrial appendage occluders (LAAO) are most frequently used in patients with contraindications for oral anticoagulation (OAC); therefore, the classical therapeutic OAC scheme from the PROTECT-AF trial (vitamin K antagonist plus acetylsalicylic acid) is usually changed to dual anti-platelet therapy (DAPT) after implantation of a Watchman® or Amulet® LAAO (St. Jude Medical/Abbott, Eschborn, Germany). For many years, patients with an LAAO received DAPT for 1-6 months. The current standard comprises DAPT for 3 months, followed by permanent acetylsalicylic acid monotherapy if the transesophageal echocardiogram excludes a thrombus at the site of the LAAO...
December 2017: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/29158017/left-atrial-appendage-occlusion-exclusion-procedural-image-guidance-with-transesophageal-echocardiography
#9
REVIEW
Alan F Vainrib, Serge C Harb, Wael Jaber, Ricardo J Benenstein, Anthony Aizer, Larry A Chinitz, Muhamed Saric
Atrial fibrillation is the most common arrhythmia worldwide and is a major risk factor for embolic stroke. In this article, the authors describe the crucial role of two- and three-dimensional transesophageal echocardiography in the pre- and postprocedural assessment and intraprocedural guidance of percutaneous left atrial appendage (LAA) occlusion procedures. Although recent advances have been made in the field of systemic anticoagulation with the novel oral anticoagulants, these medications come with a significant risk for bleeding and are contraindicated in many patients...
November 17, 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/29130638/thromboembolism-after-watchman-tm-in-a-clopidogrel-non-responder-a-case-for-concern
#10
Ganesh Venkataraman, Kevin P Bliden, Udaya S Tantry, Paul A Gurbel
Atrial fibrillation (AF) is associated with an increased risk of stroke and thromboembolism (TE). The WATCHMAN(TM) left atrial appendage (LAA) closure device is indicated to reduce the risk of TE from the LAA in patients with non-valvular AF. Here, we present a case of a patient with device-related thrombus who suffered a TE event two months after WATCHMAN(TM) LAA closure and two weeks after switching from aspirin plus warfarin to aspirin plus clopidogrel therapy. Laboratory investigation identified the patient to be hypercoagulable and to be a non-responder to clopidogrel therapy...
November 11, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29103847/5-year-outcomes-after-left%C3%A2-atrial%C3%A2-appendage-closure-from-the-prevail-and-protect-af-trials
#11
Vivek Y Reddy, Shephal K Doshi, Saibal Kar, Douglas N Gibson, Matthew J Price, Kenneth Huber, Rodney P Horton, Maurice Buchbinder, Petr Neuzil, Nicole T Gordon, David R Holmes
BACKGROUND: The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that left atrial appendage closure (LAAC) with the Watchman device (Boston Scientific, St. Paul, Minnesota) was equivalent to warfarin for preventing stroke in atrial fibrillation, but had a high rate of complications. In a second randomized trial, PREVAIL (Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy), the complication rate was low...
November 4, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29080014/-available-transvenous-occluder-designs-and-implantation-techniques
#12
REVIEW
P Sick, T Lewalter
In this article, most of the present or available in the near future left atrial appendage (LAA) occlusion devices are discussed in terms of structure of the devices and principle technique for implantation. Thus, the Watchman™ device from Boston, the Amulet™ device from Abbot, the Lambre™ device from Lifetech, the Occlutech® device from Occlutech®, and the WaveCrest® device from Biosense Webster (former Coherex) are discussed. The systems differ in terms of the concept of occlusion. Several devices consist of only one part (Watchman™ and Occlutech®) that is implanted in the body, ending up in the orifice of the LAA...
October 27, 2017: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/28988455/safety-profiles-of-percutaneous-left-atrial-appendage-closure-devices-an-analysis-of-the-food-and-drug-administration-manufacturer-and-user-facility-device-experience-maude-database-from-2009-2016
#13
Mohammad-Ali Jazayeri, Venkat Vuddanda, Mohit K Turagam, Valay Parikh, Madhav Lavu, Donita Atkins, Matthew Earnest, Luigi Di Biase, Andrea Natale, David Wilber, Yeruva Madhu Reddy, Dhanunjaya Lakkireddy
BACKGROUND: Percutaneous left atrial appendage closure (LAAC) is a viable option for AF patients who are unable to tolerate long term oral anticoagulation (OAC). OBJECTIVE: We sought to assess the safety of two commonly used percutaneous devices for LAA closure in the United States by analysis of surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database. METHODS: The MAUDE database was queried between May 1, 2006 and May 1, 2016 for LARIAT® (SentreHEART Inc...
October 8, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28898453/echocardiographic-guidance-and-monitoring-of-left-atrial-appendage-closure-with-atriclip-during-open-chest-cardiac-surgery
#14
Rachele Contri, Sara Clivio, Tiziano Torre, Tiziano Cassina
Left atrial appendage (LAA) closure prevents thromboembolic risk and avoids lifelong anticoagulation due to atrial fibrillation (AF). Nowadays, AtriClip, a modern epicardial device approved in June 2010, allows external and safe closure of LAA in patients undergoing cardiac surgery during other open-chest cardiac surgical procedures. Such a surgical approach and its epicardial deployment differentiates LAA closure with AtriClip from percutaneous closure techniques such as Watchman (Boston Scientific, Marlborough, MA, USA), Lariat (SentreHEART Inc...
October 2017: Echocardiography
https://www.readbyqxmd.com/read/28877379/short-term-safety-and-efficacy-of-left-atrial-appendage-closure-with-the-watchman-device-in-patients-with-small-left-atrial-appendage-ostia
#15
Ganesh Venkataraman, S Adam Strickberger, Shephal Doshi, Christopher R Ellis, Dhanunjaya Lakkireddy, S Patrick Whalen, Frank Cuoco
INTRODUCTION: Left atrial appendage (LAA) closure with the WATCHMAN device, according to FDA labelling, is recommended in patients with a maximal LAA ostial width between 17 and 31 mm. The safety and efficacy of LAA closure in patients with a maximal LAA ostial width < 17 mm has not been evaluated. The goal of this study was to determine the acute and short-term safety and efficacy of LAA closure with the WATCHMAN device in patients with a maximal LAA ostial width < 17 mm...
September 6, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28818408/serial-assessment-of-natriuretic-peptides-in-patients-undergoing-interventional-closure-of-the-left-atrial-appendage
#16
Blerim Luani, Thomas Rauwolf, Thomas Groscheck, Ivan Tanev, Joerg Herold, Berend Isermann, Alexander Schmeisser, Rüdiger C Braun-Dullaeus
BACKGROUND: Closure of the left atrial appendage (LAA) to prevent cardioembolic events is an alternative therapy to oral anticoagulation in patients with non-valvular atrial fibrillation. The LAA is an important source of natriuretic peptides and its exclusion from the circulation may alter the blood level of these hormones, thereby influencing their diagnostic value and clinical effects. METHODS: We aimed to prospectively assess potential changes in mid-regional pro A-type natriuretic peptide (MR-proANP) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels six weeks and six months after interventional LAA closure using the Watchman device...
August 1, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28761682/a-comparative-study-of-different-imaging-modalities-for-successful-percutaneous-left-atrial-appendage-closure
#17
Danny Hf Chow, Gintautas Bieliauskas, Fadi J Sawaya, Oscar Millan-Iturbe, Klaus F Kofoed, Lars Søndergaard, Ole De Backer
OBJECTIVES: Accurate sizing of the left atrial appendage (LAA) is essential when performing percutaneous LAA closure. This study aimed to compare different LAA imaging modalities and sizing methods in order to obtain successful LAA closure. BACKGROUND: Percutaneous LAA closure is an increasingly used treatment strategy to prevent stroke in patients with atrial fibrillation. LAA sizing has typically been done by 2D-transoesophageal echocardiography (TEE). METHODS: Patients who had a preprocedural TEE and preprocedural and postprocedural multislice CT (MSCT) were identified...
2017: Open Heart
https://www.readbyqxmd.com/read/28675629/long-term-follow-up-after-left-atrial-appendage-occlusion-with-comparison-of-transesophageal-echocardiography-versus-computed-tomography-to-guide-medical-therapy-and-data-about-postclosure-cardioversion
#18
Benjamin Berte, Christine Attenhofer Jost, Dominik Maurer, Anja Fäh-Gunz, Xavier Pillois, Barbara Naegeli, Monica Pfyffer, Gabor Sütsch, Christoph Scharf
AIMS: The use of left atrial appendage (LAA) occluders in atrial fibrillation is increasing. There are few data on the comparison between transesophageal echocardiography (TEE) and computed tomography (MDCT) assessing peridevice flow and outcome of electrical cardioversion (ECV) in these patients. METHODS AND RESULTS: Single-center prospective registry from 2009 to 2015 including all LAA occluders to analyze success and complications during implantation and follow-up...
October 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28667807/improved-algorithm-for-ostium-size-assessment-in-watchman-left-atrial-appendage-occlusion-using-three-dimensional-echocardiography
#19
Maximilian Schmidt-Salzmann, Felix Meincke, Felix Kreidel, Tobias Spangenberg, Alexander Ghanem, Karl-Heinz Kuck, Martin W Bergmann
AIMS: Correct sizing of the ostium is a crucial step in left atrial appendage (LAA) occlusion procedures. However, unfavorable anatomy of the ostium often complicates the assessment of the true ostium diameter. We hypothesized that area-derived diameter (ADD) and perimeter-derived diameter (PDD) from three-dimensional transesophageal echocardiogram (3D-TEE) can facilitate this step of the procedure as compared with two-dimensional (2D) measurements. METHODS AND RESULTS: For 55 patients within the ALSTER-LAA registry, retrospective analysis of PDD and ADD was correlated with 2D measurements used during the procedure to ascertain correct size of the Watchman device (Boston Scientific)...
July 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28606886/early-anticoagulation-drug-regimens-after-watchman-left-atrial-appendage-closure-safety-and-efficacy
#20
Martin W Bergmann, Timothy R Betts, Horst Sievert, Boris Schmidt, Evgeny Pokushalov, Stephan Kische, Thomas Schmitz, Felix Meincke, Kenneth M Stein, Lucas V Boersma, Hüseyin Ince
AIMS: While LAA closure has recently been incorporated in both European and US guidelines for stroke prevention, uncertainties regarding post-procedural drug therapy so far limit its adoption. METHODS AND RESULTS: 1005 patients were implanted with a WATCHMAN device in the prospective EWOLUTION study at 47 centers. 73.5% of the patients were deemed contraindicated for long-term OAC therapy. Here we report on 3-months data including the first follow-up TOE exam for 94% of the study population...
June 13, 2017: EuroIntervention
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