Percutaneous closure of the left atrial appendage in patients with diabetes mellitus

Azizy, Obayda; Rammos, Christos; Lehmann, Nils; Rassaf, Tienush; Kälsch, Hagen

doi:10.1177/1479164117712176

Cited by 7 publications

(4 citation statements)

References 42 publications

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“…So far, procedural safety of LAAC with Amplatzer occluders was assessed according to single factors of the CHADS 2 or HAS‐BLED score and similar results were found for patients at higher age, 19 with reduced kidney function, 20 or diabetes mellitus 21 and two studies have reported safety data in patients with very high stroke risk. Kebernik et al published major procedural complication rates of 7.3% in 96 patients with a median CHADS 2 score of 4 points in patients receiving Amplatzer‐LAAC 22 .…”

Section: Discussionmentioning

confidence: 70%

Impact of individual stroke risk on outcome after Amplatzer left atrial appendage closure in patients with atrial fibrillation

Häner

Fürholz

Kleinecke

et al. 2020

Cathet Cardio Intervent

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Objectives To investigate periprocedural and long‐term outcome of left atrial appendage closure (LAAC) using Amplatzer occluders with respect to individual pre‐procedural stroke risk. Background LAAC is a proven strategy for prevention from stroke and bleeding in patients with nonvalvular atrial fibrillation not amenable to oral anticoagulation. Whether individual pre‐procedural stroke risk may affect procedural and long‐term clinical outcome after LAAC is unclear. Methods Multicenter study of consecutive patients who underwent Amplatzer‐LAAC. Using pre‐procedural CHADS2 score, outcomes were compared between a low (0–2 points) and a high stroke risk group (3–6 points). Results Five hundred consecutive patients (73.9 ± 10.1 years) who underwent Amplatzer‐LAAC. Two hundred and forty eight had preprocedural CHADS2 score ≤ 2 points (low‐risk group) and the remaining 252 patients had 3–6 points (high‐risk group). Periprocedural complication rates (6.0% vs. 5.6%, p = .85), procedural success (LAAC without major periprocedural or device‐related complications or major para‐device leaks: 89.4% vs. 87.9%, p = .74), and 30‐day‐mortality (2.4% vs. 2.6%, p = .77) were comparable. After 1,346 patient‐years (PY), the long‐term composite efficacy endpoint (stroke, systemic embolism, cardiovascular, and unexplained death) was reached in 23/653 (3.5/100 PY) versus 52/693 (7.5/100 PY); HR = 2.13; 95%‐CI, 1.28–3.65, p = .002) with stroke rates 67% and 68% lower than anticipated by preprocedural CHADS2 score. Combined safety endpoint (major periprocedural complications and major, life‐threatening or fatal bleedings) occurred in 22/653 (3.4/100 PY) versus 28/693 (4.0/100 PY); HR = 1.20; 95%‐CI, 0.66–2.20, p = .52). Conclusions Compared with patients at low risk of stroke, LAAC with Amplatzer devices is associated with similar safety and efficacy in high‐risk patients in our study.

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Section: Discussionmentioning

confidence: 70%

Impact of individual stroke risk on outcome after Amplatzer left atrial appendage closure in patients with atrial fibrillation

Häner

Fürholz

Kleinecke

et al. 2020

Cathet Cardio Intervent

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“…The post-implant drug regimen was discontinuation of OAC followed by dual-antiplatelet therapy with aspirin 100 mg and clopidogrel 75 mg daily for 3 to 6 months, following a loading dose of clopidogrel of 600 mg [ 15 ]. All patients were followed up with TOE after 6 months.…”

Section: Methodsmentioning

confidence: 99%

“…However, major bleeding risk of OACs remain high and higher costs of OACs lead to poorer cost effectiveness [12]. Recently, LAA closure (LAAC) has been shown not to be inferior to OAC for stroke prevention, according to the PROTECT-AF and PREVAIL clinical trials [13][14][15]. Left atrial appendage closure thus plays an important role as an alternative to OAC for stroke prevention in patients with AF, reducing the bleeding risk [16][17][18], and could be a potential alternative to OAC in patients with AF and CDK.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous left atrial appendage closure for stroke prevention in patients with chronic renal disease

et al. 2020

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Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia in the general population. Atrial fibrillation is associated with an increased risk of thromboembolic events, particularly stroke. Chronic kidney disease (CKD) is associated with a higher prevalence of AF and is an independent risk factor of increased mortality and stroke in AF patients. Left atrial appendage closure (LAAC) for stroke prevention plays an important role in the treatment of patients with AF and increased bleeding risk. The impact of CKD on outcomes after LAAC has not been deeply investigated. We assessed whether percutaneous LAAC is safe and feasible in CKD patients. Material and methods: Ninety-seven patients (mean age 73.9 ±8.5 years) with AF and contraindications for oral anticoagulation (OAC) or complications under OAC underwent LAAC with the Amplatzer Cardiac Plug and the Amplatzer Amulet Occluder in an open-label observational single-center study. We classified patients as having normal to mild (KDOQI stage I-II) or moderate to severe (KDOQI stage III-V) CKD. Results: Patients with moderate to severe CKD (n = 49) had increased CHA 2 DS 2-VASc and HAS-BLED scores and were at higher thromboembolic and bleeding risk (CHA 2 DS 2-VASc: 4.08 ±0.79, HAS-BLED: 4.76 ±0.69) than patients with mild to moderate CKD (n = 48, CHA 2 DS 2-VASc: 3.69 ±1.1, HAS-BLED: 4.06 ±0.66; p < 0.001 for both). In both groups, procedural and occlusion success was similar (97.9% vs. 95.9%; p = 0.479). Follow-up of 6 months and from 12 to 36 months revealed effective stroke prevention and no bleeding complication in both groups. Conclusions: In spite of a higher thromboembolic and bleeding risk in patients with severe CKD, LAAC is a safe and feasible option for stroke prevention.

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“…Although AF patients with DM are at higher risk for bleeding and thromboembolism, outcomes after LAAC appear comparable to those in non-diabetics. 104,105 However, a recent multicenter study of 277 patients with LAAC and prior gastrointestinal bleeding reported DM as a risk factor for higher mortality after LAAC. 106 Smoking was identified as an independent predictor of device-associated thrombus after LAAC with one device.…”

Section: Left Atrial Appendage Closure (Laac)mentioning

confidence: 99%

Lifestyle changes in atrial fibrillation management and intervention

Yang

Chung

2023

Cardiovasc electrophysiol

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Atrial fibrillation (AF) is one of the most common arrhythmias in adults, and its continued rise in the United States is complicated by the increased incidence and prevalence of several AF risk factors, such as obesity, physical inactivity, hypertension, obstructive sleep apnea, diabetes mellitus, coronary artery disease, and alcohol, tobacco, or caffeine use. Lifestyle and risk factor modification has been proposed as an additional pillar of AF therapy, added to rhythm control, rate control, and anticoagulation, to reduce AF burden and risk. Although emerging evidence largely supports the integration of lifestyle and risk factor management in clinical practice, randomized clinical trials investigating the long‐term sustainability and reproducibility of these benefits remain sparse. The purpose of this review is to discuss potentially reversible risk factors on AF, share evidence for the impact on AF by modification of these risk factors, and then provide an overview of the effects of reversing or managing these risk factors on the success of various AF management strategies, such as antithrombotic, rate control, and rhythm control therapies.

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Percutaneous closure of the left atrial appendage in patients with diabetes mellitus

Abstract: Despite patients with diabetes mellitus are high-risk patients, the outcome of percutaneous left atrial appendage closure is similar to patients without diabetes mellitus.

Cited by 7 publications

References 42 publications

Impact of individual stroke risk on outcome after Amplatzer left atrial appendage closure in patients with atrial fibrillation

Impact of individual stroke risk on outcome after Amplatzer left atrial appendage closure in patients with atrial fibrillation

Percutaneous left atrial appendage closure for stroke prevention in patients with chronic renal disease

Lifestyle changes in atrial fibrillation management and intervention

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