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Left atrial appendage occlusion

Mohammed Saad, Ingo Eitel, Roland Richard Tilz, Holger Thiele
No abstract text is available yet for this article.
March 8, 2018: JACC. Cardiovascular Interventions
Vlad Ciobotaru, Nicolas Combes, Claire A Martin, Eloi Marijon, Eric Maupas, Augustin Bortone, Eric Bruguière, Jean-Benoit Thambo, Emmanuel Teiger, Pénélope Pujadas-Berthault, Julien Ternacle, Xavier Iriart
AIMS: To assess the predictive value of simulation based on 3D-printed models before left atrial appendage occlusion (LAAO) for peri-device leaks (PDL) and the impact on procedural outcomes compared to conventional imaging. METHODS AND RESULTS: 76 patients referred for LAAO with double disc device underwent construction of a 3D-printed LA model using flexible photopolymer resin. An implant simulation was performed retrospectively in Group 1 (55 patients), blinded to implanted device size, and prospectively in Group 2 (21 patients)...
March 13, 2018: EuroIntervention
Vincenzo Vizzi, Maurizio Di Biasi, Giuseppe Alessandrino, Alessandro Colombo, Paolo Danna, Maurizio Viecca
No abstract text is available yet for this article.
April 2018: Heart: Official Journal of the British Cardiac Society
Apostolos Tzikas
No abstract text is available yet for this article.
April 2018: Interventional Cardiology Clinics
Michael H Hoskins, Anshul M Patel, David B DeLurgio
The epidemic of atrial fibrillation (AF) requires a comprehensive management strategy that uses the full force of available data and technology, including anticoagulation, ablative therapy, and left atrial appendage occlusion. Patient-centered care with an emphasis on shared decision-making is particularly relevant to the authors' understanding of the complexity of AF and has helped them tailor therapy in this ever-growing patient population.
April 2018: Interventional Cardiology Clinics
Ignacio Cruz-Gonzalez, Monica Fuertes-Barahona, Jose C Moreno-Samos, Rocio Gonzalez-Ferreiro, Yan Yin Lam, Pedro L Sanchez
Since the first percutaneous left atrial appendage occlusion (LAAO), many studies have shown the safety and efficacy of this technique to prevent embolic strokes in nonvavular atrial fibrillation. The design, characteristics, and clinical data of the most frequently used devices for LAAO are reviewed, including the Amplatzer cardiac plug and Amulet (Abbott Vascular), the Watchman (Boston Scientific), and the LARIAT device (SentreHEART). Similarly, newer closer devices, such as Ultraseal (Cardia), LAmbre (Lifetech), and Coherex WaveCrest (Johnson & Johnson), are also discussed...
April 2018: Interventional Cardiology Clinics
Jay Thakkar, Dimitra Vasdeki, Apostolos Tzikas, Bernhard Meier, Jacqueline Saw
Major procedural complications related to left atrial appendage occlusion (LAAO) are relatively infrequent but may be associated with major morbidity and mortality. LAAO operators should be knowledgeable about these potential complications. Prompt recognition and treatment are necessary to avoid rapid deterioration and dire consequences. With stringent guidelines on operator training, competency requirements, and procedural-technical refinements, LAAO can be performed safely with low complication rates. This article focuses on commonly used devices, as well as prevention, treatment, and management of complications of LAOO...
April 2018: Interventional Cardiology Clinics
Kasper Korsholm, Jesper Møller Jensen, Jens Erik Nielsen-Kudsk
Transcatheter left atrial appendage occlusion is increasingly used for stroke prevention in atrial fibrillation. The technique has proven effective and safe in randomized trials and multiple observational studies. The procedure is challenging due to the complex anatomy of the left atrial appendage; accurate cardiac imaging is essential for procedural guidance. Transesophageal echocardiography is the gold standard, but cardiac computed tomography (CT) has gained increasing interest within recent years. Cardiac CT offers high-resolution imaging allowing for preprocedural anatomic evaluation and device sizing, but may also be useful for exclusion of left atrial appendage thrombus, and follow-up assessment of residual peri-device leaks...
April 2018: Interventional cardiology clinics
Dee Dee Wang, Thomas J Forbes, James C Lee, Marvin H Eng
Left atrial appendage occlusion (LAAO) is a rapidly evolving technology. Multi-modality imaging and understanding of left atrial appendage anatomy are sure to advance. Two-dimensional and 3-dimensional transesophageal echocardiography with fluoroscopy are the mainstay for LAAO image-guided therapy. Key to successful LAAO is an understanding of the transseptal puncture, LAAO size selection for the device-specific landing zone, and postdeployment evaluation for leak and complications. With advancements in computed tomography, there may be a greater role for intracardiac echocardiographic imaging in specific types of LAAO anatomy and devices...
April 2018: Interventional Cardiology Clinics
Nathan Messas, Reda Ibrahim
Percutaneous left atrial appendage occlusion (LAAO) for stroke prevention in patients with atrial fibrillation has significantly advanced in the past 2 decades. LAAO has emerged as a feasible and safe alternative to oral anticoagulants in patients who are deemed high risk for bleeding or are ineligible to receive anticoagulation. Herein, the authors review the main design features of the AMPLATZER Amulet device and describe step-by-step technical considerations for implantation of this LAAO device.
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
Bernhard Meier, Wim Stegink, Apostolos Tzikas
AMPLATZER devices preceded WATCHMAN occluder in 2002 for catheter-based left atrial appendage occlusion. The AMPLATZER technique facilitates simultaneous closure of atrial shunts using two devices through one gear. Randomized WATCHMAN follow-up data showed a mortality benefit over warfarin. AMPLATZER data make this likely valid for the strategy. Particularly young people with atrial fibrillation should be offered left atrial appendage occlusion because the risk is confined to the intervention and early postintervention period...
April 2018: Interventional Cardiology Clinics
David R Holmes, Robert S Schwartz, George G Latus, Robert A Van Tassel
A new era in antiembolic therapy has been initiated by the growing numbers of device-based therapies. Early concerns surrounding eliminating this enigmatic structure have not proven true. Other benefits are being further evaluated. Many other questions remain, such as whether there is a device-specific outcome effect or whether it is a class effect. Other questions include other devices, what head-to-head studies will show, and the impact of residual leak. Left atrial appendage using the Watchman ablation strategy can reduce cardioembolic stroke, with comparable or fewer adverse effects by device technology than obtained by long-term anticoagulation with its attendant bleeding risks...
April 2018: Interventional Cardiology Clinics
Heyder Omran, Apostolos Tzikas, Horst Sievert, Frederike Stock
Percutaneous left atrial appendage occlusion was introduced as an alternative method for prevention of thromboembolism in patients with nonvalvular atrial fibrillation after extensive animal work in 2001. The first device was named Percutaneous Left Atrial Appendage Transcatheter Occlusion (PLAATO) and patented by the company Appriva. The device was invented by Michael Lesh, MD.
April 2018: Interventional Cardiology Clinics
Patrizio Mazzone, Giuseppe D'Angelo, Damiano Regazzoli, Giulio Molon, Gaetano Senatore, Salvatore Saccà, Guido Canali, Claudia Amellone, Riccardo Turri, Paolo Della Bella
PURPOSE: The WATCHMAN device for Left Atrial Appendage Occlusion (LAAO) has proven to be an effective alternative to oral anticoagulation (OAC) in patients with atrial fibrillation (AF), and has now been adopted in clinical practice. In the present study, we analyzed the safety and efficacy profile of the LAAO procedure at mid-term follow-up. METHODS: The TRAPS Registry is an observational, multicenter registry involving four Italian centers. Consecutive patients who had undergone LAAO with WATCHMAN device were enrolled...
March 10, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Grzegorz Suwalski, Robert Emery, Jakub Mróz, Kamil Kaczejko, Leszek Gryszko, Andrzej Cwetsch, Andrzej Skrobowski
OBJECTIVES: In patients undergoing cardiac surgical procedures, pulmonary vein isolation may be easily accomplished, and it is important to achieve bidirectional conduction block across created lesions. The primary aim of this study was to assess the risk of pulmonary vein stenosis (PVS) after multiple applications of epicardial bipolar radiofrequency energy. METHODS: Thirty-five consecutive patients who were referred for off-pump coronary revascularization with concomitant pulmonary vein isolation and left atrial appendage occlusion were prospectively included in the study...
March 7, 2018: Interactive Cardiovascular and Thoracic Surgery
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
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
Charan Yerasi, Mohamad Lazkani, Prathik Kolluru, Varun Miryala, Jae Kim, Harsha Moole, Abhishek C Sawant, Michael Morris, Ashish Pershad
BACKGROUND: Left atrial appendage occlusion (LAAO) is a promising intervention for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Early outcomes following LAAO have been published in many studies with variable results. OBJECTIVE: This updated meta-analysis aims to provide a summary of the early outcomes of LAAO. METHODS: Medline/Pubmed, Ovid Journals, Clinical trials, Abstract meetings, Cochrane databases were searched from January 1st, 1999 to November 30th, 2016...
March 1, 2018: Journal of Interventional Cardiology
Apostolos Tzikas
It has been over a decade since dedicated Amplatzer devices have been used for left atrial appendage occlusion (LAAO) in patients with atrial fibrillation. The first was the Amplatzer Cardiac Plug (ACP) that is now replaced in most countries by the Amplatzer Amulet device. Most of the clinical data for ACP come from the ACP multicenter registry that included 1047 patients from 22 sites, whereas the largest to date report on the Amplatzer Amulet is a recently published prospective multicenter study in 1088 patients from 64 sites...
December 2017: Journal of Atrial Fibrillation
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