EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update

Glikson, Michael; Wolff, Rafael; Hindricks, Gerhard; Mandrola, John; Camm, A. John; Lip, Gregory Y.H.; Fauchier, Laurent; Betts, Timothy R.; Lewalter, Thorsten; Saw, Jacqueline; Tzikas, Apostolos; Sternik, Leonid; Nietlispach, Fabiàn; Berti, Sérgio; Sievert, Horst; Bertog, Stefan; Meier, Bernhard

doi:10.1093/europace/euz258

Cited by 212 publications

(211 citation statements)

References 185 publications

Supporting

Mentioning

194

Contrasting

Unclassified

Order By: Relevance

“…AF patients with relevant risk for thromboembolic stroke should be treated with long-term oral anticoagulation (OAC) [1]. For NVAF patients with a substantially elevated risk for stroke and contraindications for OAC, it is recommended to consider the interventional closure of the left atrial appendage (LAAC) [1][2][3]. LAAC using percutaneous, catheter-based methods was first performed in 2001 with the PLAATO™ device [4].…”

Section: Introductionmentioning

confidence: 99%

Systematic review on left atrial appendage closure with the LAmbre device in patients with non-valvular atrial fibrillation

Ali

Rigopoulos

Mammadov

et al. 2020

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background: Percutaneous closure (LAAC) of the left atrial appendage (LAA) is an efficacious preventive procedure for patients with non-valvular atrial fibrillation (NVAF) and considerable bleeding risk. We sought to systematically review the available LAAC data on the novel occluder device LAmbre™. Methods: For this systematic review, a search of the literature was conducted by 3 independent reviewers, reporting the safety and therapeutic success of LAAC in patients being treated with a LAmbre™. Publications reporting the safety and therapeutic success of LAAC using LAmbre™ in n > 5 patients were included. Results: The literature search retrieved n = 10 publications, encompassing n = 403 NVAF patients treated with a LAmbre™ LAAC, with relevant data regarding safety and therapeutic success of the procedure. The mean CHA 2 DS 2-VASc Score was 4.0 + 0.9, and the mean HAS-BLED score was 3.4 + 0.5. The implantation success was 99.7%, with a mean procedure time of 45.4 ± 18.7 min, and a fluoroscopy time of 9.6 ± 5.9 min, and a contrast agent volume of 96.7 ± 0.7 ml. The anticoagulation regimen was switched to DAPT post procedure in the majority of the patients (96.8%). Partial and full recapture were done in 45.5% and in 25.6%, respectively. Major complications were reported in 2.9%, with 0.3% mortality, 1.7% pericardial tamponade, 0.3% stroke, and 0.6% major bleeding complications; no device embolization was observed. During follow up at 6 or 12 months, major adverse cardiovascular events were reported in 3.3%: Stroke or TIA in 1.7%, thrombus formation on the device in 0.7%, and residual flow > 5 mm in 1.0%. In some publications, the favorable implantion properties of the LAmbre™ for difficult anatomies such as shallow or multilobular LAA anatomies were described. Conclusions: This systematic review on the LAmbre™ LAA-occluder including n = 403 NVAF patients demonstrates an excellent implantion success rate, promising follow-up clinical data, and favorable properties for also challenging LAA anatomies,. While its design seems to be helpful in preventing device embolization, pericardial tamponade may not be substantially reduced by the LAmbre™ as compared with other established LAAC devices. Further larger prospective multicenter registries and randomized trials are needed to scrutinize the value of the LAmbre™ compared with established LAAC devices.

show abstract

Section: Introductionmentioning

confidence: 99%

Systematic review on left atrial appendage closure with the LAmbre device in patients with non-valvular atrial fibrillation

Ali

Rigopoulos

Mammadov

et al. 2020

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…Briefly, the device was implanted under echocardiographic and fluoroscopic guidance via femoral venous access via the transseptal route into the LAA. Accurate device position was confirmed by angiography and echocardiography (Figure ). After implantation, patients received a dual platelet therapy with aspirin 100 mg/d and clopidogrel 75 mg/d for 1 to 3 months, followed by a monotherapy with aspirin 100 mg/d for at least 6 months or—in the case of corresponding indications—lifelong therapy with aspirin 100 mg/d.…”

Section: Methodsmentioning

confidence: 92%

“…Exclusion criteria were mechanical prosthetic heart valve, life expectancy <1‐year, active endocarditis, and intracardiac thrombus. Indications, contraindications, and anatomical requirements for left atrial appendage occlusion were described previously …”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Risk stratification in patients undergoing interventional left atrial appendage occlusion—Prognostic impact of EuroSCORE II

Gotzmann

Choudhury

Hogeweg

et al. 2020

Clinical Cardiology

View full text Add to dashboard Cite

Background: Interventional closure of the left atrial appendage (LAA) is an alternative option to stroke prophylaxis, particularly in multimorbid patients with a high risk of bleeding under oral anticoagulation. Due to the multiple comorbidities, the prognosis of patients is reduced, and the clinical benefit of the procedure is therefore questionable in the individual patient.Hypothesis: The present study aims to identify independent preprocedural risk factors to improve risk stratification in these highly selected patients. Methods: This study consecutively included 128 patients who received an interventional LAA occlusion with Amplatzer device (St Jude Medical, St Paul, Minnesota). The preinterventional risk assessment was performed with the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) II. The primary endpoint was all-cause mortality. Secondary endpoints were thromboembolic events and severe bleeding.Results: During a follow-up of 781 ± 498 days the primary endpoint (all-cause mortality) was reached in 35 patients (27%). The only independent predictor of mid-term mortality was a logistic EuroSCORE II > 2% (Hazard risk [HR] 4.55, confidence interval [CI] 1.599-12.966, P = .005). In our study, 33 patients (26%) suffered from endstage renal disease which was not associated with increased mortality (P = .371), increased thromboembolic events (P = .475), or severe bleeding (P = .613). Conclusions:In patients undergoing interventional LAA occlusion, preprocedural assessment of logistic EuroSCORE II provide independent prognostic information.This parameter might help to improve risk stratification in these highly selected patients. In contrast, terminal renal failure was not associated with a significantly worse outcome. K E Y W O R D Sinterventional left atrial appendage occlusion, logistic EuroSCORE II, mid-term mortality, risk stratification

show abstract

“…However, high risk of cardiac thrombosis remains if AF is recurrent. In such situations with co-existing bleeding complication, left atrial appendage occlusion (LAAO), currently regarded as a non-inferior alternative to anticoagulation in patients with non-valvular AF [4,5], is useful to reduce the risk of thrombosis and bleeding. Here, we report a case of simultaneous percutaneous PVS stenting and LAAO to resolve the dilemma.…”

Section: Introductionmentioning

confidence: 99%

Combined pulmonary vein stenosis stenting and left atrial appendage occlusion in a patient with hemoptysis after atrial fibrillation ablation

Pan

Wang

et al. 2020

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background: Pulmonary vein stenosis (PVS) after radiofrequency ablation for non-valvular atrial fibrillation (AF) is an uncommon but serious complication. PVS stenting can rapidly restore pulmonary flow and improve symptoms with long-term low incidence of restenosis. However, high risk of thrombosis remains if AF is recurrent, especially for CHA 2 DS 2-VASc > 2. Case presentation: A 67-year-old man with diabetes, hypertension and a history of stroke underwent radiofrequency pulmonary vein isolation for persistent AF 1 year ago. Six months later he developed recurrent respiratory infection and massive hemoptysis. Computed tomography pulmonary angiography revealed severe left pulmonary vein stenosis. Simultaneous percutaneous PVS stenting and left atrial appendage occlusion were performed to resolve recurrent hemoptysis and prevent stroke. The clinical follow-up indicated a good short and mid-term result with significant improvement of symptoms. Conclusions: Simultaneous PVS stenting and left atrial appendage occlusion is feasible and effective in patients with recurrence of AF and hemoptysis induced by radiofrequency ablation for AF.

show abstract

EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update

Cited by 212 publications

References 185 publications

Systematic review on left atrial appendage closure with the LAmbre device in patients with non-valvular atrial fibrillation

Systematic review on left atrial appendage closure with the LAmbre device in patients with non-valvular atrial fibrillation

Risk stratification in patients undergoing interventional left atrial appendage occlusion—Prognostic impact of EuroSCORE II

Combined pulmonary vein stenosis stenting and left atrial appendage occlusion in a patient with hemoptysis after atrial fibrillation ablation

Contact Info

Product

Resources

About