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https://www.readbyqxmd.com/read/27910092/management-of-atrial-fibrillation-in-elderly-adults
#1
Yaanik Desai, Mikhael F El-Chami, Angel R Leon, Faisal M Merchant
Driven in large part by the aging of the population and the increasing prevalence of cardiovascular comorbidities associated with atrial fibrillation (AF), there is a burgeoning epidemic of AF in elderly adults. Although there is a large body of literature to guide management of people with AF, elderly adults with AF are frequently underrepresented in clinical trials. This review provides a contemporary update on management of elderly adults with AF with a particular focus on the two main clinical challenges that AF poses: stroke risk reduction and control of symptoms...
December 2, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27909476/atrial-fibrillation-and-risk-of-dementia-cognitive-decline
#2
REVIEW
Anand D Shah Md, Faisal M Merchant Md, David B Delurgio Md
Emerging evidence suggests a link between atrial fibrillation and subsequent development of dementia. While a majority of risk can be attributed to cardioembolic stroke secondary to atrial fibrillation, additional risk is apparent, and may be driven by vascular inflammation and changes in cerebral perfusion. Medical therapies including anticoagulation, statin therapy, and angiotensin-renin-aldosterone axis antagonists may reduce dementia risk. Procedural therapies such as atrial fibrillation catheter ablation and left atrial appendage closure may also prove to be important mediators of acute and long-term risk...
February 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27903589/impact-of-left-atrial-appendage-closure-during-cardiac-surgery-on-the-occurrence-of-early-postoperative-atrial-fibrillation-stroke-and-mortality-a-propensity-score-matched-analysis-of-10-633-patients
#3
Rowlens M Melduni, Hartzell V Schaff, Hon-Chi Lee, Bernard J Gersh, Peter A Noseworthy, Kent R Bailey, Naser M Ammash, Stephen S Cha, Kaniz Fatema, Waldemar E Wysokinski, James B Seward, Douglas L Packer, Charanjit S Rihal, Samuel J Asirvatham
BACKGROUND: -Prophylactic exclusion of the left atrial appendage (LAA) is often performed during cardiac surgery ostensibly to reduce the risk of stroke. However, the clinical impact of LAA closure in humans remains inconclusive. METHODS: -Out of 10,633 adults who underwent CABG and/or valve surgery between January 2000 and December 2005, 9,792 patients with complete baseline characteristics, surgery procedure and follow-up data were included in this analysis. A propensity-score matching analysis based on 28 pretreatment covariates was performed and 461 matching pairs were derived and analyzed to estimate the association of LAA closure with early postoperative atrial fibrillation (POAF) (AF ≤30 days of surgery), ischemic stroke and mortality...
November 30, 2016: Circulation
https://www.readbyqxmd.com/read/27903032/-interventional-left-atrial-appendage-closure-in-a-patient-with-gave-syndrome
#4
Christian Fastner, Sebastian Belle, Ibrahim Akin
History and findings | A 56-year-old female with a gastric antral vascular ectasia (GAVE) suffered from recurrent episodes of upper gastrointestinal bleeding. Because of a history of a permanent atrial fibrillation (CHA2DS2-VASc score 3 points) an oral anticoagulation therapy with phenprocoumon was carried out which even worsened the bleeding frequency and intensity. A change of medication to low-molecular weight heparin did not lead to success. The frequent periods in hospital limited the patient's quality of life...
November 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27898435/percutaneous-left-atrial-appendage-closure-current-state-of-the-art
#5
Mohammad-Ali Jazayeri, Venkat Vuddanda, Valay Parikh, Dhanunjaya R Lakkireddy
PURPOSE OF REVIEW: The authors reviewed the seminal and more recent literature surrounding the major modalities for percutaneous left atrial appendage closure used in contemporary practice, with particular emphasis on safety and efficacy, technical challenges, and future developments. RECENT FINDINGS: Along with the continued practice of surgical left atrial appendage closure, which has evolved substantially with the advent of clipping techniques, a number of percutaneous methods have been developed to close the left atrial appendage with endocardial, epicardial, and hybrid approaches...
January 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/27867289/amplatzer-cardiac-plug-for-stroke-prevention-in-patients-with-atrial-fibrillation-and-bigger-left-atrial-appendix-size
#6
Yoga Yuniadi, Dicky A Hanafy, Sunu B Raharjo, Ario Soeryo, IIf Yasmina, Amiliana M Soesanto
Left atrial appendage (LAA) dimensions have been shown as an independent predictor of higher risk for stroke in AF patients. Little data exist on the outcomes after LAA closure in patients with nonvalvular atrial fibrillation (NVAF) who have relatively bigger LAA size. This study aims to evaluate the results associated with LAA closure with the Amplatzer cardiac plug (ACP, AGA, St. Jude Medical, Minneapolis, MN) in bigger LAA size. A total of 25 patients with NVAF underwent LAA closure with the ACP device. All patients received short-term (up to 3 months) dual-antiplatelet therapy (clopidogrel and aspirin) after the procedure and aspirin only thereafter...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/27864311/late-dehiscence-of-left-atrial-appendage-closure-device
#7
Santosh K Padala, Parikshit S Sharma, Walter H J Paulsen, Vigneshwar Kasirajan, John D Grizzard, Matthew Sackett, Kenneth A Ellenbogen
No abstract text is available yet for this article.
December 2016: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/27862233/transesophageal-echocardiographic-diagnosis-of-a-watchman-left-atrial-appendage-closure-device-thrombus-10%C3%A2-years-following-implantation
#8
Shariq Shamim, Anthony Magalski, Adnan C Chhatriwalla, Keith B Allen, Kenneth C Huber, Michael L Main
Left atrial appendage closure with the WATCHMAN device is an alternative to chronic oral anticoagulation for thromboembolic prophylaxis in atrial fibrillation patients. Left atrial device-related thrombus (DRT) has been described in the first year after implant with an incidence of ~6%. A 79-year-old man underwent WATCHMAN device placement in 2006. Routine protocol specified follow-up transesophageal echocardiograms (TEE) at 6 weeks, 6 months, and 1 year following implant showed no evidence for DRT or peri-device flow...
November 16, 2016: Echocardiography
https://www.readbyqxmd.com/read/27860249/left-atrial-appendage-closure-initial-experience-with-the-ultraseal-device
#9
Ander Regueiro, Mathieu Bernier, Gilles O'Hara, Kim O'Connor, Jean-Michel Paradis, Jonathan Beaudoin, Tania Rodriguez-Gabella, Jean Champagne, Josep Rodés-Cabau
OBJECTIVES: We report the initial experience of percutaneous left atrial appendage (LAA) closure with the Ultraseal device. BACKGROUND: LAA closure is an alternative to oral anticoagulation for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) and high risk of bleeding. The Ultraseal device is a new LAA closure prosthesis that consists of a distal soft bulb and a proximal sail attached by an articulating joint that allows a high degree of device conformability to the different variations of the LAA anatomy...
November 17, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27826128/durability-of-wide-area-left-atrial-appendage-isolation-results-from-extensive-catheter-ablation-for-the-treatment-of-persistent-atrial-fibrillation
#10
Bruno Reissmann, Andreas Rillig, Erik Wissner, Roland Tilz, Michael Schlüter, Christian Sohns, Christian Heeger, Shibu Mathew, Tilman Maurer, Christine Lemes, Thomas Fink, Peter Wohlmuth, Francesco Santoro, Johannes Riedl, Feifan Ouyang, Karl-Heinz Kuck, Andreas Metzner
BACKGROUND: Extensive ablation strategies are currently performed in addition to pulmonary vein isolation (PVI) to improve the clinical outcome of patients with drug-refractory persistent atrial fibrillation (AF). Ablation of complex fractionated atrial electrograms (CFAE), linear lesions and/or isolation of the left atrial appendage (LAA) are thought to improve arrhythmia-free survival. OBJECTIVE: This study sought to assess the durability of wide-area LAA isolation (LAAI) achieved by PVI, an anterior line and a mitral isthmus line...
November 5, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/27824417/-anticoagulation-and-new-therapeutic-options-in-atrial-fibrillation
#11
Karl Mischke
Oral anticoagulation plays an essential role in the treatment of patients with atrial fibrillation as it is indicated for most patients to reduce the risk of stroke. It is prudent to assess the risks of stroke and bleeding using the CHA2DS2-VASc and HAS-BLED scores. Oral anticoagulation is indicated in general for all patients with valvular atrial fibrillation (atrial fibrillation in moderate to severe mitral stenosis or mechanical prosthetic valve) as well as for patients with a CHA2DS2-VASc-Score of 1 - 2 points or higher...
October 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27822906/simultaneous-large-bi-atrial-device-related-thrombi
#12
Jonas Dominik Häner, Christian Seiler
Simultaneous appearance of a pacemaker-lead associated thrombus and a left atrial appendage closure device related thrombus in a patient with urothelial carcinoma shown in a transesophageal echocardiography.
November 7, 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27818146/spanish-cardiac-catheterization-and-coronary-intervention-registry-25th-official-report-of-the-spanish-society-of-cardiology-working-group-on-cardiac-catheterization-and-interventional-cardiology-1990-2015
#13
Pilar Jiménez-Quevedo, Ana Serrador, Armando Pérez de Prado, Manuel Pan
INTRODUCTION AND OBJECTIVES: The Working Group on Cardiac Catheterization and Interventional Cardiology presents its annual report on the data from the registry of the activity in 2015. METHODS: All Spanish hospitals with catheterization laboratories were invited to voluntarily contribute their activity data. The information was collected online and analyzed mostly by an independent company. RESULTS: In 2015, 106 centers participated in the national register; 73 of these centers are public...
November 3, 2016: Revista Española de Cardiología
https://www.readbyqxmd.com/read/27816552/post-fda-approval-initial-us-clinical-experience-with-watchman-left-atrial-appendage-closure-for-stroke-prevention-in-atrial-fibrillation
#14
Vivek Y Reddy, Douglas N Gibson, Saibal Kar, William O'Neill, Shephal K Doshi, Rodney P Horton, Maurice Buchbinder, Nicole T Gordon, David R Holmes
BACKGROUND: Left atrial appendage closure (LAAC) using the Watchman device was FDA-approved as a stroke prevention alternative to warfarin for patients with non-valvular atrial fibrillation. However, clinical decision-making is confounded by the fact that while LAAC avoids the anticoagulant-related lifetime risk of bleeding, implantation is associated with up-front complications. Thus, enthusiasm for LAAC as a treatment option has been appropriately tempered, particularly as the therapy is introduced beyond the clinical trial sites into general clinical practice...
October 27, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27816551/assessing-the-safety-of-early-u-s-commercial-application-of-left-atrial-appendage-closure
#15
EDITORIAL
Jacqueline Saw, Matthew J Price
No abstract text is available yet for this article.
October 19, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27815629/pulmonary-artery-perforation-and-coronary-air-embolism-two-fatal-outcomes-in-percutaneous-left-atrial-appendage-occlusion
#16
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...
November 4, 2016: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/27807929/imaging-for-percutaneous-left-atrial-appendage-closure
#17
Roshan Prakash, Jacqueline Saw
Percutaneous left atrial appendage (LAA) closure is increasingly performed worldwide as an alternative to long-term oral anticoagulation, especially for patients who are considered ineligible for anticoagulation. This is a complex procedure with success that hinges upon good understanding of the LAA and surrounding structures anatomy. Multimodality imaging can provide important three-dimensional appreciation of the LAA anatomy, which facilitates procedural safety and success. Thus, proceduralists and imagers involved with LAA closure should have good comprehension of such imaging modalities (cardiac CT angiography, transesophageal echocardiography, and/or intracardiac echocardiography) prior to embarking on this procedure...
November 3, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27800191/successful-left-atrial-appendage-occlusion-with-the-new-generation-amulet%C3%A2-device-after-late-occurring-embolization-of-an-amplatzer%C3%A2-cardiac-plug-in-a-patient-with-repetitive-strokes
#18
Marco R Schroeter, Wolfgang Schillinger
The Amplatzer Cardiac Plug (ACP) is one of the most commonly used devices for percutaneous left atrial appendage (LAA) closure in order to prevent a stroke in patients with atrial fibrillation and contraindication for long-term oral anticoagulation therapy. We have previously described a patient who had experienced an embolization of the ACP device about 12 months after implantation and the device could be percutaneously retrieved. A few years later, he suffered from a posterior stroke and a stroke located in the brainstem as well as a transischemic attack (TIA)...
2016: Case Reports in Cardiology
https://www.readbyqxmd.com/read/27771552/use-of-non-warfarin-oral-anticoagulants-instead-of-warfarin-during-left-atrial-appendage-closure-with-the-watchman-device
#19
Yoshinari Enomoto, Varuna K Gadiyaram, Carola Gianni, Rodney P Horton, Chintan Trivedi, Sanghamitra Mohanty, Luigi Di Biase, Amin Al-Ahmad, J David Burkhardt, Arvin Narula, Gwen Janczyk, Matthew J Price, Muhammad R Afzal, Moustapha Atoui, Matthew Earnest, Vijay Swarup, Shephal K Doshi, Sarina van der Zee, Rebecca Fisher, Dhanunjaya R Lakkireddy, Douglas N Gibson, Andrea Natale, Vivek Y Reddy
BACKGROUND: In the stroke prevention trials of left atrial appendage closure with the Watchman device (Boston Scientific), a postimplantation antithrombotic regimen of 6 weeks of warfarin was used. OBJECTIVE: Given the clinical complexity of warfarin use, the purpose of this study was to study the relative feasibility and safety of using non-warfarin oral anticoagulants (NOACs) instead of warfarin during the peri- and initial postimplantation periods after Watchman implantation...
October 19, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/27769756/intra-atrial-excision-of-the-left-atrial-appendage-a-simple-and-easy-technique
#20
Shigeaki Aoyagi, Eiki Tayama, Takeshi Oda, Tomokazu Kosuga, Hiroshi Yasunaga
In patients with atrial fibrillation, closure of the left atrial appendage (LAA) is recommended to prevent thromboembolic events, however, conventional exclusion or excision techniques have potential drawbacks such as persistent blood flow into the appendage and a residual stump. We propose a simple and easy technique for LAA closure consisting of intra-atrial excision of the LAA, which is invaginated into the left atrium (LA), and direct suture closure of the orifice from inside the LA. In this technique, complete elimination of the LAA was achieved without leaving a residual stump because the LAA was excised at the orifice and was closed at the base of the LAA...
September 9, 2016: Heart, Lung & Circulation
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