Percutaneous methods of left atrial appendage exclusion: an alternative to the internist

Le, Duong; Khodjaev, Soidjon; Morelli, Remo

doi:10.3402/jchimp.v4.22719

Cited by 5 publications

(4 citation statements)

References 23 publications

(41 reference statements)

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“…Oral anticoagulation (OAC) therapy is usually prescribed on those AF patients older than 65 years old (Morillo et al, 2017) to reduce the risk of thrombus formation. When OAC therapy is not appropriate, due to high risk of bleeding or because of patient's limitations, a physical LAA closure is performed with the implantation of a left atrial appendage occlusion (LAAO) device or surgery-based clipping (Le et al, 2014). LAAO devices are implanted percutaneously by a femoral vein approach under fluoroscopic and echocardiographic guidance.…”

Section: Introductionmentioning

confidence: 99%

In silico Optimization of Left Atrial Appendage Occluder Implantation Using Interactive and Modeling Tools

et al. 2019

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According to clinical studies, around one third of patients with atrial fibrillation (AF) will suffer a stroke during their lifetime. Between 70 and 90% of these strokes are caused by thrombus formed in the left atrial appendage. In patients with contraindications to oral anticoagulants, a left atrial appendage occluder (LAAO) is often implanted to prevent blood flow entering in the LAA. A limited range of LAAO devices is available, with different designs and sizes. Together with the heterogeneity of LAA morphology, these factors make LAAO success dependent on clinician's experience. A sub-optimal LAAO implantation can generate thrombi outside the device, eventually leading to stroke if not treated. The aim of this study was to develop clinician-friendly tools based on biophysical models to optimize LAAO device therapies. A web-based 3D interactive virtual implantation platform, so-called VIDAA, was created to select the most appropriate LAAO configurations (type of device, size, landing zone) for a given patient-specific LAA morphology. An initial LAAO configuration is proposed in VIDAA, automatically computed from LAA shape features (centreline, diameters). The most promising LAAO settings and LAA geometries were exported from VIDAA to build volumetric meshes and run Computational Fluid Dynamics (CFD) simulations to assess blood flow patterns after implantation. Risk of thrombus formation was estimated from the simulated hemodynamics with an index combining information from blood flow velocity and complexity. The combination of the VIDAA platform with in silico indices allowed to identify the LAAO configurations associated to a lower risk of thrombus formation; device positioning was key to the creation of regions with turbulent flows after implantation. Our results demonstrate the potential for optimizing LAAO therapy settings during pre-implant planning based on modeling tools and contribute to reduce the risk of thrombus formation after treatment.

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Section: Introductionmentioning

confidence: 99%

In silico Optimization of Left Atrial Appendage Occluder Implantation Using Interactive and Modeling Tools

et al. 2019

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“…Процедура Lariat осуществляется с помо-щью одноименной системы (Sentre HEART, Palo Alto, CA, USA), состоящей из трех компонентов: 1) баллонного катетера; 2) эпикардиального и эндокардиального катетеров с магнитами на концах; 3) эпикардиальной системы для доставки петли лигатуры (рис. 6) [35,36].…”

Section: Index Terms: Atrial Fibrillation; Left Atrial Appendage; Occlusion Devices; Endovascular Methods For Closure Of the Left Atrial unclassified

Endovascular Methods for Closure of the Left Atrial Appendage in Patients With Nonvalvular Atrial Fibrillation for Stroke Prevention

Guchaev¹,

Певзнер²,

Меркулов³

et al. 2018

Vestn. rentgenol. radiol.

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Фибрилляция предсердий (ФП)одно из самых распространенных нарушений ритма сердца, которым страдает 2% взрослого населения [1]. Это состояние увеличивает риск инсульта в 5 раз [1, 2]. До 15-20% всех случаев инсультов связано с ФП [1, 2]. Ишемический инсульт (ИИ) у больных с ФП часто заканчивается смертельным исходом и по сравнению с ИИ, вызванным другими причинами (не ФП), при-водит к наиболее выраженной инвалидизации и чаще рецидивирует [3]. Независимо от формы ФП (пароксизмальная или постоянная) риск развития ИИ в течение года составляет 4,5% [4].

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“…4 Thromboembolic stroke from the left atrial appendage (LAA) is the most feared complication. 5 Patients with ischemic stroke have a significantly worse prognosis than other stroke patients, with increased mortality. The patients who survive have loss of independence and requirement for a high level of care.…”

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confidence: 99%

To Study the Risk Factors for Atrial Fibrillation and the Relation Between Cardiac Symptoms with Left Atrial Area on Echocardiography

Mangudkar¹,

Gokhale²,

Shivnitwar³

et al. 2020

jebmh

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A BS T R A C T BACKGROUNDAtrial fibrillation (AF) is the most common arrhythmia. It is associated with significant morbidity and mortality. Size of the left atrium (LA) is an important factor for atrial fibrillation which can land subjects into various complications. We wanted to study the echocardiography findings (size of LA) among AF cases with various underlying aetiology. METHODSA cross-sectional observational study was conducted for a duration of 2 years to measure left atrial size by echocardiography in patients of atrial fibrillation in various diseases. A proforma was designed to collect the desired information from the patients. The preformed structured proforma consisted of recording of investigations and was used as data collection tool. All efforts were made to determine the aetiology of atrial fibrillation. RESULTSA total of 50 cases of AF were studied. Major risk factors found were RHD (44%) Hypertension (28%) and IHD (24%). LA volume on echo was determined and it was found that the majority of symptoms (palpitation, breathlessness, chest pain) was associated with dilated LA. CONCLUSIONSAtrial fibrillation (AF) is associated with significant morbidity and mortality and to find out the underlying aetiology will help in reducing the same. The size of left atrium is found to have association with various cardiac symptoms and also an important role in atrial fibrillation particularly in patients of rheumatic heart disease which predisposes the patients to stroke and other cardio-embolic events. Hence, timely management will help in reducing the morbidity and mortality significantly.

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Percutaneous methods of left atrial appendage exclusion: an alternative to the internist

Cited by 5 publications

References 23 publications

In silico Optimization of Left Atrial Appendage Occluder Implantation Using Interactive and Modeling Tools

In silico Optimization of Left Atrial Appendage Occluder Implantation Using Interactive and Modeling Tools

Endovascular Methods for Closure of the Left Atrial Appendage in Patients With Nonvalvular Atrial Fibrillation for Stroke Prevention

To Study the Risk Factors for Atrial Fibrillation and the Relation Between Cardiac Symptoms with Left Atrial Area on Echocardiography

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