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Left Atrial Appendage

Roman Piotrowski, Tomasz Imiela, Beata Zaborska, Tomasz Kryński, Piotr Kułakowski
No abstract text is available yet for this article.
2018: Kardiologia Polska
Mohammed Saad, Ingo Eitel, Roland Richard Tilz, Holger Thiele
No abstract text is available yet for this article.
March 8, 2018: JACC. Cardiovascular Interventions
Kang An, Hang Yin, Ju Mei, Jiaquan Zhu, Min Tang
OBJECTIVES: We retrospectively analysed data from non-valvular atrial fibrillation (AF) patients who underwent minimally invasive surgical AF ablation at our centre. Our purpose was to explore the atrial endocardial expression of von Willebrand factor (vWF) and thrombomodulin (TM) and their association with rhythm results after the procedure. METHODS: From January 2014 to May 2015, 60 patients underwent minimally invasive surgical AF ablation at our centre. Left atrial appendage samples were obtained during the procedure and immunohistochemistry for endocardial markers including vWF and TM was performed and semi-quantitatively graded...
March 14, 2018: Interactive Cardiovascular and Thoracic Surgery
Lisette Wintgens, Aleksandr Romanov, Karen Phillips, Gabriel Ballesteros, Martin Swaans, Richard Folkeringa, Ignacio Garcia-Bolao, Evgeny Pokushalov, Lucas Boersma
Aims: Long-term freedom from atrial fibrillation (AF) after catheter ablation (CA) and consequently the potential for stroke reduction remain unpredictable. Percutaneous left atrial appendage closure (LAAC) is an effective mechanical alternative to oral anticoagulation (OAC) for stroke prevention in AF patients. This study aims to evaluate long-term clinical results of combined CA and LAAC in one single procedure. Methods and results: Patients with non-valvular AF who underwent combined CA and LAAC procedure were included in the retrospective compilation of independent prospective general LAAC registries at the individual centres...
March 13, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Cheng Jin, Jianjiang Feng, Lei Wang, Heng Yu, Jiang Liu, Jiwen Lu, Jie Zhou
In this paper, we present an approach for left atrial appendage (LAA) multi-phase fast segmentation and quantitative assisted diagnosis of atrial fibrillation (AF) based on 4D-CT data. We take full advantage of the temporal dimension information to segment the living, flailed LAA based on a parametric max-flow method and graph-cut approach to build 3-D model of each phase. To assist the diagnosis of AF, we calculate the volumes of 3-D models, and then generate a "volume-phase" curve to calculate the important dynamic metrics: ejection fraction, filling flux, and emptying flux of the LAA's blood by volume...
March 9, 2018: Computers in Biology and Medicine
Jeffrey Hsu, Shamone Gore-Panter, Gregory Tchou, Laurie Castel, Beth Lovano, Christine S Moravec, Gosta B Pettersson, Eric E Roselli, A Marc Gillinov, Kenneth R McCurry, Nicholas G Smedira, John Barnard, David R Van Wagoner, Mina K Chung, Jonathan D Smith
BACKGROUND: Genome-wide association studies have identified 23 loci for atrial fibrillation (AF), but the mechanisms responsible for these associations, as well as the causal genes and genetic variants, remain undefined. METHODS: To identify the effect of common genetic variants on gene expression that might explain the mechanisms linking genome-wide association loci with AF risk, we performed RNA sequencing of left atrial appendages from a biracial cohort of 265 subjects...
March 2018: Circ Genom Precis Med
Emmanuel Teiger, Jean-Benoit Thambo, Pascal Defaye, Jean-Sylvain Hermida, Sélim Abbey, Didier Klug, Jean-Michel Juliard, Jean-Luc Pasquie, Gilles Rioufol, Antoine Lepillier, Meyer Elbaz, Jerome Horvilleur, Philippe Brenot, Bertrand Pierre, Philippe Le Corvoisier
BACKGROUND: Percutaneous left atrial appendage (LAA) closure is an emerging option for patients with atrial fibrillation at high risk for cerebrovascular events. The multicenter FLAAC registry (French Nationwide Observational LAA Closure Registry) was established to assess LAA closure outcomes in everyday practice. METHODS AND RESULTS: Four hundred thirty-six patients referred from April 2013 to September 2015 to 33 French interventional cardiology centers for percutaneous LAA closure were included prospectively in the FLAAC registry...
March 2018: Circulation. 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
Alessandro Satriano, Edward J Vigmond, David S Schwartzman, Elena S Di Martino
Mechanical stretch plays a major role in modulating atrial function, being responsible for beat-by-beat responses to changes in chamber preload, enabling a prompt regulation of cardiac function. Mechano-electric coupling (MEC) operates through many mechanisms and has many targets, making it experimentally difficult to isolate causes and effects especially under sinus conditions where effects are more transient and subtle. Therefore, modelling is a powerful tool to help understand the role of MEC with respect to the atrial electromechanical interaction...
February 21, 2018: Computers in Biology and Medicine
Yoshinari Enomoto, Go Hashimoto, Naohiko Sahara, Hikari Hashimoto, Hiroki Niikura, Keijiro Nakamura, Raisuke Iijima, Hidehiko Hara, Makoto Suzuki, Mahito Noro, Masao Moroi, Kaoru Sugi, Masato Nakamura
A 70-years-old male with a history of hypertension and drug resistant paroxysmal atrial fibrillation (AF) presented to our hospital for catheter ablation to his symptomatic AF. He had no prior surgical or percutaneous procedure to close or exclude the left atrial appendage (LAA). A transesophageal echocardiography (TEE) was performed to rule out intra-cardiac thrombus prior to the ablation procedure. Although the TEE imaging at multiple acquisition angles was obtained, the LAA could not be visualized and an absence of the LAA was suspected...
March 12, 2018: International Heart Journal
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
Randomized clinical trials have demonstrated that left atrial appendage (LAA) closure with the WATCHMAN device provides stroke prevention in nonvalvular atrial fibrillation while significantly reducing morality and major bleeding. Technical and procedural considerations are paramount for the therapeutic success. Maximizing procedural safety is critical. Optimal LAA sealing is required. Improvements in procedural technique and operator training have resulted in a marked reduction in adverse procedural events, which should increase the absolute long-term clinical benefit...
April 2018: Interventional Cardiology Clinics
Nicholas Y Tan, Omar Z Yasin, Alan Sugrue, Abdallah El Sabbagh, Thomas A Foley, Samuel J Asirvatham
The left atrial appendage has been implicated as a major nidus for thrombus formation, particularly in atrial fibrillation. This discovery has prompted substantial interest in the development of left atrial appendage exclusion devices aimed at decreasing systemic thromboembolism risk. Its deceptively simple appearance belies the remarkable complexity that characterizes its anatomy and physiology. We highlight the key anatomic features and variations of the left atrial appendage as well as its relationships with surrounding structures...
April 2018: Interventional Cardiology Clinics
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