Percutaneous left atrial appendage occlusion in the current practice

Cruz-González, Ignacio; Trejo-Velasco, Blanca

doi:10.33963/kp.15864

Cited by 11 publications

(14 citation statements)

References 30 publications

(60 reference statements)

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“…In exceptional situations, TTE is sufficient to make a diagnosis, as was the case in the described patient with very high embolic potential. In patients with non-valvular AF and unstable oral anticoagulation percutaneous LAA closure may be an alternative method for stroke prevention [5]; however, in our patient, the coexistence of AF and moderate mitral valve stenosis was confirmed.…”

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confidence: 54%

A large left atrial appendage thrombus revealed on transthoracic echocardiography as a cause of acute lower limb ischemia

et al. 2022

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Figure 1. A. Transmitral mean gradient (6 mm Hg) indicating moderate mitral stenosis; continuous wave Doppler; B. Additional mass (thrombus) visible in the slightly enlarged left atrium (the arrow); 3D TTE, four-chamber view; C. Additional structure (thrombus) fixed in the place of the left atrium appendage (the arrow); 2D TTE, two-chamber view; D. Absence of pathological mass in the area of the left atrium appendage (the arrow); 2D TTE, two-chamber view; E. Lower-extremity computed tomographic angiography showing occlusion of the distal part of the right common femoral artery, right superficial femoral artery and deep femoral artery (red arrows). Normal flow in the left superficial femoral artery (yellow arrow

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confidence: 54%

A large left atrial appendage thrombus revealed on transthoracic echocardiography as a cause of acute lower limb ischemia

et al. 2022

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“…Post-LAAC warfarin treatment is feasible in patients without contraindications to anticoagulation therapy. There are also several trials assessing the post-procedure NOAC regimen with favorable outcomes, but until we get the results of ongoing randomized trial, there is no indication for such treatment [ 13 ]. There is a growing amount of evidence for the effectiveness of post-procedure antiplatelet therapy, and our population consists of patients with either a contraindication to OAC or its failure, which is why VKA was not administered after the LAAC procedure.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of percutaneous atrial appendage closure followed by antiplatelet therapy in a high-risk population: single-center experience with a WATCHMAN device

Maksym,

Kapłon-Cieślicka,

Scisło

et al. 2023

pwki

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Introduction:In our everyday practice we encounter many patients with non-valvular atrial fibrillation with either a contraindication to oral anticoagulation or with its inefficiency.Aim: To investigate whether left atrial appendage closure (LAAC) followed by post-procedure antiplatelet therapy is safe and efficient in a high-risk population.Material and methods: Ninety-one (48 males) consecutive patients with non-valvular atrial fibrillation (NVAF) underwent an LAAC procedure using a first-generation WATCHMAN 2.5 device followed by antiplatelet therapy. Clinical and transesophageal echocardiography data were collected at baseline and at the follow-up visit.Results: The median (IQR) CHA 2 DS 2 -VASc score was 5 (4.0-6.0) and the HAS-BLED score was 3 (3.0-4.0); the mean (SD) age was 74.4 (8.4). A bleeding history was observed in 89% of patients and 24.2% of patients had a history of stroke or transient ischemic attack (TIA). The procedure was successful in 98.9%. Post-procedure therapy was dual antiplatelet therapy in 85 patients; 3 patients received single antiplatelet therapy and the therapy was maintained until the follow-up visit. Peri-procedural complications were tamponade (3.3%), pericardial effusion (2.2%) and two deaths (2.2%) with no bleeding or vascular complications. The median follow-up was 67 (52.75-84.75) days. Primary safety endpoint (bleeding BARC type 3 or more, tamponade, pericardial effusion, and device embolization) and primary efficacy endpoint (stroke or TIA, hemorrhagic stroke, peripheral embolism, cardiovascular (CV) and non-CV death) were observed in 2 and 4 patients, respectively.Conclusions: The LAAC procedure followed by antiplatelet therapy seems to be safe and efficient in the high-risk population. Further studies in this field are required.

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“…In addition, multiple registries have reported favourable outcomes for the WATCHMAN, Amplatzer Cardiac Plug and Amulet devices (Abbott) in patients with a higher bleeding risk and contraindications to short-term OAC for whom less intensive post-LAAO anticoagulation regimens were required. [ 63 ] There is also growing evidence of the efficacy and safety of newer devices with distinct characteristics that may be of value to specific patient subgroups. [ 63 ]…”

Section: Left Atrial Appendage Occlusionmentioning

confidence: 99%

“…[ 63 ] There is also growing evidence of the efficacy and safety of newer devices with distinct characteristics that may be of value to specific patient subgroups. [ 63 ]…”

Section: Left Atrial Appendage Occlusionmentioning

confidence: 99%

Association Between Left Atrial Appendage Morphology and Function and the Risk of Ischaemic Stroke in Patients with Atrial Fibrillation

Dudzińska-Szczerba

Kułakowski

Michałowska

2022

Arrhythm Electrophysiol Rev

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AF is the most common cardiac arrhythmia and has been identified as an independent risk factor for stroke. The European Society of Cardiology guidelines recommend a thromboembolic event risk assessment based on the CHA2DS2-VASc score. However, stroke also occurs in some patients with a low CHA2DS2-VASc score. Therefore, it is necessary to find new factors to improve thromboembolic risk stratification in AF patients. Over 90% of embolic strokes are caused by thrombi originating from the left atrial appendage (LAA). Thus, certain anatomical or functional parameters of the LAA could potentially be used to predict cardioembolic stroke. Studies have suggested that some of these factors, such as LAA morphology, number of LAA lobes, LAA dimensions, LAA volume, distance from the LAA ostium to the first bend of LAA, LAA orifice diameter, extent of LAA trabeculations, LAA takeoff, LAA flow velocity and LAA strain rate, are independently associated with a higher risk of stroke in a population of patients with AF and improve the performance of the CHA2DS2-VASc score. However, the results are conflicting and, so far, no new parameter has been added to the CHA2DS2-VASc score.

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Percutaneous left atrial appendage occlusion in the current practice

Cited by 11 publications

References 30 publications

A large left atrial appendage thrombus revealed on transthoracic echocardiography as a cause of acute lower limb ischemia

A large left atrial appendage thrombus revealed on transthoracic echocardiography as a cause of acute lower limb ischemia

Safety and efficacy of percutaneous atrial appendage closure followed by antiplatelet therapy in a high-risk population: single-center experience with a WATCHMAN device

Association Between Left Atrial Appendage Morphology and Function and the Risk of Ischaemic Stroke in Patients with Atrial Fibrillation

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