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laa occluder

Christian Fastner, Michael Behnes, Benjamin Sartorius, Annika Wenke, Ibrahim El-Battrawy, Uzair Ansari, Ishar-Singh Gill, Martin Borggrefe, Ibrahim Akin
BACKGROUND: The interventional left atrial appendage (LAA) closure represents an emerging alternative to oral anticoagulation for stroke prevention in certain atrial fibrillation patients. Preliminary results have suggested high procedural success rates and fewer peri-interventional complications; however, there persists an insufficient understanding of the role of many underlying confounding variables (e.g., anatomical characteristics). HYPOTHESIS: It was investigated whether varying LAA morphologies influence procedural success as well as in-hospital outcome...
April 13, 2017: Clinical Cardiology
Ibrahim Akin, Christoph A Nienaber
Non-valvular atrial fibrillation is associated with a significantly increased risk of embolic stroke due to blood clot forming predominantly in the left atrial appendage (LAA). Preventive measures to avoid embolic events are permanent administration of anticoagulants or surgical closure of the LAA. Various clinical trials provide evidence about safety, effectiveness and therapeutic success of LAA occlusion using various cardiac occluder devices. The use of such implants for interventional closure of the LAA is likely to become a valuable alternative for stroke prevention, especially in patients with contraindication for oral anticoagulation as safety, clinical benefit and cost-effectiveness of LAA occlusion has recently been demonstrated...
February 26, 2017: World Journal of Cardiology
Rong Bai
While oral anticoagulants (OACs) remains the main strategy of prevention of thromboembolic event in patients with atrial fibrillation (AF), left atrial appendage closure (LAAC) has become an alternative recently. The concept of this technique is based on the understanding that in more than 90% non-valvular AF patients, the thrombi form in the left atrial appendage (LAA), so excluding the LAA from the systemic circulation can prevent stroke or peripheral arterial embolization. To achieve this goal, novel trans-catheter techniques have been developed to either occlude the LAA endocardially or ligate the LAA epicardially...
February 9, 2017: Pacing and Clinical Electrophysiology: PACE
Orly Goitein, Noam Fink, Ilan Hay, Elio Di Segni, Victor Guetta, David Goitein, Yafim Brodov, Eli Konen, Michael Glikson
AIM: To investigate the role of cardiac CT angiography (CCTA) in predicting optimal left atrial appendage (LAA) occluder size and procedure outcome. METHODS AND RESULTS: Thirty-six patients underwent pre-procedural CCTA. CCTA and TEE LAA orifice diameters and perimeters were compared with the implanted device size. CCTA 3D configuration was correlated with procedure outcome. Watchman™ device (N = 18): diameters were 21 ± 4, 26 ± 5 and 25 ± 3 mm for TEE, CCTA and inserted device, respectively...
January 9, 2017: International Journal of Cardiovascular Imaging
J Zwirner, R Bayer, C Hädrich, A Bollmann, N Klein, J Dreßler, B Ondruschka
Percutaneous left atrial appendage (LAA) closure is a routinely performed method to reduce the risk of stroke in patients suffering from atrial fibrillation, when an oral anticoagulation is no longer indicated due to relevant bleeding complications. Currently, the Amplatzer Amulet and the Watchman system are two equally used systems. While there is an acute success rate of more than 95 per cent for this intervention, several minor and major complications such as pericardial effusions, air embolism, vascular lesions in proximity to the heart or even death can occur...
January 2017: International Journal of Legal Medicine
Mathias Lange, Helmut Bültel, Heinrich Weglage, Patrick Löffeld, Thomas Wichter
A 73-year-old patient with permanent atrial fibrillation presented for left atrial appendage (LAA) occlusion. Transesophageal echocardiography demonstrated a thrombus in the distal LAA. This image series illustrates a "no touch" technique that was used to ensure successful implantation of an Amplatzer Amulet LAA occlusion device without the use of an embolization protection system.
September 2016: Journal of Invasive Cardiology
Jakob Ledwoch, Christine Krollmann, Stephan Staubach, Martin Hug, Henning Strohm, Harald Mudra
OBJECTIVES: We sought to evaluate the effect of increasing experience with left atrial appendage (LAA) closure on short-term outcome. BACKGROUND: Data regarding the impact of the learning curve of LAA closure-particularly regarding technical aspects of the procedure-are lacking. METHODS: The present analysis represents first data from a single-center all-comer registry. The population was divided into 3 groups according to treatment time (group 1: patients 1-30; group 2: patients 31-60; group 3: patients 61-90)...
August 2016: Journal of Interventional Cardiology
Gaetano Fassini, Sergio Conti, Massimo Moltrasio, Anna Maltagliati, Fabrizio Tundo, Stefania Riva, Antonio Dello Russo, Michela Casella, Benedetta Majocchi, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Mauro Pepi, Claudio Tondo
AIMS: Pulmonary veins (PVs) isolation is the cornerstone of atrial fibrillation (AF) ablation and can be achieved either by conventional radiofrequency ablation or by cryoenergy. Left atrial appendage (LAA) closure has been proposed as alternative treatment to vitamin K antagonists (VKA). We aimed to evaluate the feasibility of combining cryoballoon (CB) ablation and LAA occlusion in patients with AF and a high thromboembolic risk or contraindication to antithrombotic therapy. METHODS AND RESULTS: Thirty-five patients (28 males, 74 ± 2 years) underwent CB ablation...
November 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Konstantinos C Koskinas, Samera Shakir, Máté Fankhauser, Fabian Nietlispach, Adrian Attinger-Toller, Aris Moschovitis, Peter Wenaweser, Thomas Pilgrim, Stefan Stortecky, Fabien Praz, Lorenz Räber, Stephan Windecker, Bernhard Meier, Steffen Gloekler
OBJECTIVES: The aim of this study was to assess predictors of adverse 1-week outcomes and determine the effect of left atrial appendage (LAA) morphology following LAA closure (LAAC) with Amplatzer devices. BACKGROUND: Percutaneous LAAC is a valuable treatment option for stroke prevention in patients with atrial fibrillation. Determinants of procedural safety events with Amplatzer occluders are not well established, and the possibly interrelating effect of LAA anatomy is unknown...
July 11, 2016: JACC. Cardiovascular Interventions
M Brzeziński, K Bury, L Dąbrowski, P Holak, A Sejda, M Pawlak, D Jagielak, Z Adamiak, J Rogowski
INTRODUCTION: Many patients undergoing cardiac surgery have risk factors for both atrial fibrillation (AF) and stroke. The left atrial appendage (LAA) is the primary site for thrombi formation. The most severe complication of emboli derived from LAA is stroke, which is associated with a 12-month mortality rate of 38% and a 12-month recurrence rate of 17%. The most common form of treatment for atrial fibrillation and stroke prevention is the pharmacological therapy with anticoagulants...
2016: PloS One
Grzegorz Suwalski, Robert Emery, Leszek Gryszko, Kamil Kaczejko, Arkadiusz Żegadło, Emilia Frankowska, Jakub Mróz, Andrzej Skrobowski
INTRODUCTION: Atrial fibrillation (AF) increases long-term mortality and stroke rate in patients having coronary artery bypass grafting (CABG). Because oral anticoagulation (OAC) is associated with both a significant incidence of discontinuation and well known complication rates, left atrial appendage occlusion might be beneficial for stroke prevention. This study presents the first clinical and practical comparison of two epicardial left appendage occluders (LAAO) accruing experience in application during off-pump coronary revascularisation in patients with persistent AF...
March 2016: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
Grzegorz Suwalski, Robert Emery, Leszek Gryszko, Kamil Kaczejko, Jakub Mroz, Andrzej Skrobowski
OBJECTIVES: Epicardial left atrial appendage (LAA) closure with use of occluder is an emerging technique. Absence of remnant LAA stump is major criterion of successful obliteration. The aim of study was to assess early success rate of epicardial LAA closure. METHODS: Fifteen patients with persistent AF and coronary artery disease underwent off-pump coronary revascularization with concomitant ablation and LAA epicardial occlusion with use of two types of occluders...
September 2016: Echocardiography
Petru Mester, Antoine Dompnier, Loïc Belle
An 84-year-old woman with a history of hemorrhagic stroke was admitted for a new cerebral ischemic event. While in hospital, she was diagnosed with paroxysmal atrial fibrillation. Owing to her high thromboembolic risk (CHA2 DS2 -VASc score of 6) we performed left atrial appendage (LAA) closure using a 22-mm AMPLATZER™ Amulet™. The procedure was successful. Systematic follow-up with transthoracic echocardiography 8 hr later revealed that the LAA occluder had migrated and become entrapped in the mitral subvalvular apparatus...
May 3, 2016: Catheterization and Cardiovascular Interventions
Giuseppe Patti, Vittorio Pengo, Rossella Marcucci, Plinio Cirillo, Giulia Renda, Francesca Santilli, Paolo Calabrò, Alberto Ranieri De Caterina, Ilaria Cavallari, Elisabetta Ricottini, Vito Maurizio Parato, Giacomo Zoppellaro, Giuseppe Di Gioia, Pietro Sedati, Vincenzo Cicchitti, Giovanni Davì, Enrica Golia, Ivana Pariggiano, Paola Simeone, Rosanna Abbate, Domenico Prisco, Marco Zimarino, Francesco Sofi, Felicita Andreotti, Raffaele De Caterina
The left atrial appendage (LAA) is the main source of thromboembolism in patients with non-valvular atrial fibrillation (AF). As such, the LAA can be the target of specific occluding device therapies. Optimal management of patients with AF includes a comprehensive knowledge of the many aspects related to LAA structure and thrombosis. Here we provide baseline notions on the anatomy and function of the LAA, and then focus on current imaging tools for the identification of anatomical varieties. We also describe pathogenetic mechanisms of LAA thrombosis in AF patients, and examine the available evidence on treatment strategies for LAA thrombosis, including the use of non-vitamin K antagonist oral anticoagulants and interventional approaches...
April 26, 2016: European Heart Journal
Michael Behnes, Ibrahim Akin, Benjamin Sartorius, Christian Fastner, Ibrahim El-Battrawy, Martin Borggrefe, Holger Haubenreisser, Mathias Meyer, Stefan O Schoenberg, Thomas Henzler
BACKGROUND: A standardized imaging proposal evaluating implanted left atrial appendage (LAA) occlusion devices by cardiac computed tomography angiography (cCTA) has never been investigated. METHODS: cCTA datasets were acquired on a 3(rd) generation dual-source CT system and reconstructed with a slice thickness of 0.5 mm. An interdisciplinary evaluation was performed by two interventional cardiologists and one radiologist on a 3D multi-planar workstation. A standardized multi-planar reconstruction algorithm was developed in order to assess relevant clinical aspects of implanted LAA occlusion devices being outlined within a pictorial essay...
March 24, 2016: BMC Medical Imaging
Christian Fastner, Ralf Lehmann, Michael Behnes, Benjamin Sartorius, Martin Borggrefe, Ibrahim Akin
Intraprocedural device dislodgement of a 24-mm Watchman™ left atrial appendage (LAA) closure device occurred in a 83-year-old female with a wide left atrial appendage ostium (broccoli configuration) and a surgical mitral valve reconstruction. Device rested in the atrial cavity. A second stable 12French transseptal electrophysiological sheath and two snares were needed to stabilize, elongate and gently guide the device into the second sheath. One of the snares was unclamped at its proximal end and retrogradely pulled through...
April 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Phattaraphong Pheerawong, Smonporn Boonyaratavej Songmuang, Vorarit Lertsuwunseri, Sudarat Satitthummanid, Suphot Srimahachota
BACKGROUND: In patient with non-valvular atrial fibrillation (AF), over 90% of thrombus accumulation originates in the left atrial appendage (LAA). Warfarin significantly reduces risk of stroke. However, long-term anticoagulant therapy is associated with a significant risk of major bleeding, particularly in elderly. Transcatheter occlusion of left atrial appendage with Watchman device has proved to be non-inferior to warfarin in preventing stroke in non-valvular AF patients. No previous report of transcatheter occlusion of LAA was found in Thailand OBJECTIVE: To evaluate short-term results of left atrial appendage closure with the Watchman® device in patient with non-valvular AF performed at King Chulalongkorn Memorial Hospital (KCMH)...
October 2015: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Niv Ad, Paul S Massimiano, Deborah J Shuman, Graciela Pritchard, Sari D Holmes
OBJECTIVE: Atrial fibrillation (AF) is associated with an increased risk for embolic stroke originating from the left atrial appendage (LAA). A recently introduced LAA epicardial clip occluder, the AtriClip PRO, can be applied through midsternotomy or small thoracotomy. We assessed the safety and efficacy of a new surgical approach to apply the AtriClip PRO and exclude the LAA through right minithoracotomy and transverse sinus. METHODS: The AtriClip PRO was applied in 24 patients with the new approach...
September 2015: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
T S Potpara, V Jokic, B Medic, M Prostran, G Y Lip
Atrial fibrillation (AF) currently affects approximately 2% of the general adult population, and the number of patients suffering from AF constantly increases. Although the occurrence of AF rarely poses an immediate threat to patient's survival, the arrhythmia is associated with significant cardiovascular morbidity and mortality mostly resulting from ischemic stroke or systemic thromboembolism, or heart failure. Overall, patients with AF have a 5-fold greater risk of stroke compared to individuals in sinus rhythm, but individual stroke risk depends on the presence of various stroke risk factors, and optimal stroke prevention is essential for AF patients...
October 23, 2015: Minerva Medica
Jakob Ledwoch, Jennifer Franke, Maik Gonzaga, Stefan Bertog, Annkathrin Braut, Ilona Hofmann, Laura Vaskelyte, Sameer Gafoor, Vivek Reddy, Horst Sievert
OBJECTIVES: To evaluate the feasibility and safety of the fourth generation WATCHMAN device. BACKGROUND: The WATCHMAN left atrial appendage (LAA) closure device has been shown to be non-inferior to conventional oral anticoagulation with warfarin for stroke prevention in patients with non-valvular atrial fibrillation. A new (fourth) generation of the WATCHMAN device was designed to facilitate easier delivery and improve safety. METHODS: We conducted a prospective, non-randomized study of LAA closure with use of the 4(th) generation WATCHMAN device in 36 patients with non-valvular atrial fibrillation...
March 2016: Catheterization and Cardiovascular Interventions
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