A simple method to detect leaks after left atrial appendage occlusion with Watchman

Ayhan, Hüseyin; Mohanty, Sanghamitra; Gedikli, Ömer; Trivedi, Chintan; Canpolat, Uğur; Tapia, Alfredo Chauca; Chen, Qiong; Rocca, Domenico G. Della; Gianni, Carola; Salwan, Anu; Annanab, Alisara; MacDonald, Bryan; Mayedo, Angel; Burkhardt, J. David; Horton, Rodney; Gallinghouse, G. Joseph; Biase, Luigi Di; Al‐Ahmad, Amin

doi:10.1111/jce.14641

Cited by 5 publications

(7 citation statements)

References 18 publications

(24 reference statements)

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“…Further verification though is required. Our data are in concordance with other studies who also used echocardiographic features to classify the appearance of the LAA after LAAO into white (W) and non-white (NW) based on imaging parameters [5]. The NW group, which corresponds to our type B and C, was a predictor of a significant leak also in our analysis (OR: 47.96, CI: 2.91-790.2, p = 0.007) [5].…”

Section: Discussionsupporting

confidence: 91%

“…The diversity in anatomy and shape of the LAA makes the implantation challenging. Therefore, peri-device leaks (PDL) can occur in a number of patients [4][5][6][7][8]. Moreover, a precise definition, pathophysiologic mechanisms, and optimal management especially for those who cannot tolerate long-term anticoagulation have not been established [4,6].…”

Section: Introductionmentioning

confidence: 99%

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A Novel Echocardiographic-Based Classification for the Prediction of Peri-Device Leakage following Left Atrial Appendage Occluder Implantation

Hamadanchi

Ijuin

Haertel

et al. 2022

JCM

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(1) Background: The assessment of residual peri-device leakages (PDL) after left atrial appendage occlusion (LAAO) remains crucial for post-procedural management. Our study aimed to verify a novel echocardiographic classification for the prediction of PDL. (2) Methods: Echocardiographic data of 72 patients who underwent percutaneous LAAO were evaluated. All echo images were analyzed by two independent investigators using standard analysis software (Image-Arena IA-4.6.4.44 by TomTec®, Munich, Germany). A total number of 127 studies was evaluated. Forty-four patients had baseline studies, at 45 days and at 6 months post-implantation. We propose a morphological classification of LAA devices based on the amount of echodensity inside the devices into three types: type A showing complete homogenous thrombosis, type B incompletely thrombosed device with inhomogeneous echo-free space <50% of device, and type C with partially thrombosed device in which the echo free space was >50% of device in various planes, which we called the “ice-cream cone” sign. Each type was matched to the degree of PDL and clinical outcome parameters. (3) Results: Patients with type C had the highest percentage of PDL at 45 days follow-up (type A: 24%, type B: 31%, type C 100% PDL, p < 0.001) and at 6 months follow-up (type A: 7%, type B: 33%, type C 100% PDL, p < 0.001). Notably, device size in patients with PDL was larger than that in patients without PDL at 6 months follow-up (25.6 ± 3.5 mm vs. 28.7 ± 3.4 mm, p = 0.004). Device size in patients with type C appearance was the largest of the three types (type A: 25.9 ± 3.6 mm, type B: 25.8 ± 3.4 mm, type C 29.8 ± 3.0 mm, type A vs. C; p = 0.019; type B vs. C, p = 0.007). (4) Conclusions: In conclusion, PDL are common post-LAAO, and their frequency is underestimated and under-recognized. PDL are much more common in patients with larger LAA ostial sizes and likely lower longitudinal compression. Type C appearance of the LAAO devices (“ice-cream cone sign”) has a high positive predictive value for PDL. Further studies are needed for better delineation of the clinical importance of this proposed classification.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

A Novel Echocardiographic-Based Classification for the Prediction of Peri-Device Leakage following Left Atrial Appendage Occluder Implantation

Hamadanchi

Ijuin

Haertel

et al. 2022

JCM

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“…The main drawback of endocardial LAAO is the risk of possible thrombus formation on the occlusion device. Several antithrombotic strategies have been empirically adopted in clinical practice to avoid this worrisome complication [126,127,136,137]. To date, the most common approach is based on the use of aspirin, initially with clopidogrel and then alone, to prevent activation of platelets coming in contact with the atrial surface of the device until complete endothelialization is achieved [131][132][133][134][135].…”

Section: Non-anticoagulative Approachesmentioning

confidence: 99%

Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy

Magnocavallo

Bellasi

Mariani

et al. 2020

JCM

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Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related; several independent risk factors of AF are often frequent in CKD patients. AF prevalence is very common among these patients, ranging between 15% and 20% in advanced stages of CKD. Moreover, the results of several studies showed that AF patients with end stage renal disease (ESRD) have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD and vitamin K antagonists (VKAs), remaining the only drugs allowed, although they show numerous critical issues such as a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients.

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“…Primary endpoint was a composite of procedural success and complete LAA sealing at follow-up TEE. Successful sealing was defined as complete occlusion or presence of a peri-device leak < 3 mm with evidence of echo-dense thrombus beyond the occlusion device 10 at follow-up TEE.…”

Section: Methodsmentioning

confidence: 99%

“…The LAA exhibits great variability in size, shape, number of lobes, and orientation. 10 These features may limit the benefits and reliability of 2D echocardiography, since real-time visualization of the LAA is critical to optimize the safety and success of occlusion devices. In this perspective, 3D echocardiography features direct visualization of the LAA complex anatomy in multiplane/multislice modes with high reproducibility, thereby overcoming the need for geometric assumptions.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional intracardiac echocardiography for left atrial appendage sizing and percutaneous occlusion guidance

Della Rocca,

Magnocavallo,

Gianni

et al. 2023

Europace

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Background Left atrial appendage (LAA) imaging is critical during percutaneous occlusion procedures. 3D-intracardiac echocardiography (ICE) features direct visualization of LAA from multiple cross-sectional planes at a time. We aimed at reporting procedural success of 3D-ICE-guided LAA occlusion and the correlation between pre-procedural transesophageal echocardiography (TEE) and intraprocedural 3D-ICE for LAA sizing. Methods Among 274 patients undergoing LAAO with a Watchman FLX, periprocedural ICE guidance was achieved via a commercially available 2D-ICE catheter (220 patients) or a novel (NUVISION™) 3D-ICE one (54 patients). Primary endpoint was a composite of procedural success and LAA sealing at follow-up TEE. Secondary endpoint was a composite of periprocedural device recapture/resizing plus presence of leaks≥3mm at follow-up TEE. Results 3D-ICE measurements of maximum landing zone correlated highly with preprocedural TEE reference values [Pearson’s: 0.94; p<0.001; bias: -0.06 (-2.39, 2.27)]. The agreement between 3D-ICE-based device selection and final device size was 96.3% versus 79.1% with 2D-ICE (p=0.005). The incidence of the primary endpoint was 98.1% with 3D-ICE and 97.3% with 2D-ICE (p=0.99). 2D-ICE patients had a trend towards a higher incidence of periprocedural device recapture/redeployment (31.5% vs 44.5%; p=0.09). The secondary endpoint occurred in 31.5% of 3D-ICE patients versus 45.9% of 2D-ICE ones (p=0.065). Conclusions ICE-guided LAAO showed a very high success, with no major adverse events. A very high level of agreement for LAA sizing was found between pre-procedural TEE and periprocedural 3D-ICE. 3D-ICE performed significantly better than 2D-ICE for FLX size selection and may provide better guidance during device deployment.

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A simple method to detect leaks after left atrial appendage occlusion with Watchman

Cited by 5 publications

References 18 publications

A Novel Echocardiographic-Based Classification for the Prediction of Peri-Device Leakage following Left Atrial Appendage Occluder Implantation

A Novel Echocardiographic-Based Classification for the Prediction of Peri-Device Leakage following Left Atrial Appendage Occluder Implantation

Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy

Three-dimensional intracardiac echocardiography for left atrial appendage sizing and percutaneous occlusion guidance

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