What Lies Beneath Left Atrial Appendage Occlusion

Meier, Bernhard

doi:10.1161/circinterventions.118.006360

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…Thrombus formation on the device is difficult to define 102 but is not uncommon in patients with AF who are treated by LAA closure (3.7% to 7.2% in recent large series) and, when present, is associated with a higher rate of stroke and systemic embolism 100,171 . The more recent generation of the AMPLATZER devices (Amulet) does not seem to be associated with a lower risk of thrombus than the older generation in the few comparisons that are available 163 .…”

Section: Thrombus On the Devicementioning

confidence: 99%

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

Glikson¹,

Wolff²,

Hindricks³

et al. 2020

EuroIntervention

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211

190

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Section: Thrombus On the Devicementioning

confidence: 99%

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

Glikson¹,

Wolff²,

Hindricks³

et al. 2020

EuroIntervention

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211

190

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“…However, it may also be the result of a slightly higher, but not significantly higher rate of diabetes mellitus and a slightly higher leaks and DRT. 21,22 In a study of 330 patients with ACP devices peridevice leaks were not associated with an increased risk for ischemic events. 23 In contrast, the impact of DRT not due to peri-device leaks on ischemic events is well documented.…”

Section: Discussionmentioning

confidence: 99%

Long‐term clinical outcomes of Amplatzer cardiac plug versus Amulet occluders for left atrial appendage closure

Kleinecke

Cheikh-Ibrahim

Schnupp

et al. 2019

Cathet Cardio Intervent

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Objectives To compare long‐term clinical outcomes after left atrial appendage closure with the Amplatzer Cardiac Plug (ACP) and Amulet. Background The Amulet was designed to improve clinical outcomes of first‐generation ACP. Methods Three Amplatzer registries (Bern, Coburg, Zurich), with enrollment of patients from 2009 to 2018, were retrospectively analyzed. The primary safety endpoint was a composite of major peri‐procedural complications and major bleedings, the primary efficacy endpoint included stroke, systemic embolism, and cardiovascular/unexplained death. The net clinical benefit was a combination of all above‐mentioned hazards. Results A total of consecutive 563 patients (344 ACP vs. 219 Amulet) with a mean follow‐up of 2.9 ± 1.6 and 1.9 ± 0.9 years were included. Mean age (74.4 ± 9.9 [ACP] vs. 74.4 ± 9.1 [Amulet] years), stroke (CHA2DS2‐VASc score 4.4 ± 1.6 vs. 4.6 ± 1.7), and bleeding risk (HAS‐BLED score 3.2 ± 1.1 vs. 3.2 ± 0.9) were comparable. The primary endpoints of efficacy (72/998, 7.2% [ACP] vs. 43/417, 10.3% [Amulet]; hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.44–1.02, p = .062), safety (40/998, 4.0% vs. 18/417, 4.3%; HR, 1.15; 95% CI, 0.53–2.51, p = .72), and the net clinical benefit (101/998, 10.1% vs. 55/417, 13.4%; HR, 0.73; 95% CI, 0.49–1.07, p = .11) were similar. Conclusion In the long term, left atrial appendage closure with first and second‐generation Amplatzer devices provided similar efficacy, safety, and net clinical benefit. Clinical outcomes may be rather determined by implantation technique and hemodynamics, but not by the design modifications of the Amulet.

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“…There is clear evidence that the risk of developing DRTs is not the same for all patients but is associated with predisposing risk factors for thrombus formation such as larger LAAs, a history of thrombus formation, stroke or transient ischemic attack, permanent atrial fibrillation, spontaneous echo contrast, female sex, smoking, higher CHA2DS2-VASc score, lower LV ejection fraction, and vascular disease [12][13][14]. It has also been shown that procedural characteristics such as positioning the device too low into the LAA cavity also play a major role in the development of DRTs [15,16]. The question of whether DRTs are associated with the type of postprocedural therapy regime is more difficult to answer.…”

Section: Incidence and Clinical Significance Of Drtmentioning

confidence: 99%

Why Follow-up Examinations After Left Atrial Appendage Closure Are Important: Detection of Complications During Follow-up and How to Deal with Them

Wunderlich¹,

Lorch²,

Honold

et al. 2020

Curr Cardiol Rep

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Purpose of Review Device-related thrombus (DRT) formation and incomplete left atrial appendage closure (LAAC) are the two major complications that can occur after LAAC and can potentially limit the success of such a procedure. This review discusses the incidence, clinical and/or prognostic significance, detection methods, treatment options, and potential strategies to prevent these complications. Recent Findings It has recently been proven that the presence of a DRT represents an independent predictor for ischemic stroke after LAAC. Continued need for anticoagulation due to incomplete LAAC is clinically relevant to the patient. Summary The appearances of a DRT or an incompletely closed LAA after a LAAC procedure are not rare complications. Due to the clinical and/or prognostic significance of these complications, it is important to detect them in a timely manner during followup by using the appropriate diagnostic imaging techniques. Since a DRT is associated with an increased risk of stroke, the therapy should be aggressive. In the case of incomplete LAA closure, an additional closure device may be used to complete occlusion and avoid lifelong anticoagulation therapy.

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What Lies Beneath Left Atrial Appendage Occlusion

Cited by 9 publications

References 15 publications

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

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

Long‐term clinical outcomes of Amplatzer cardiac plug versus Amulet occluders for left atrial appendage closure

Why Follow-up Examinations After Left Atrial Appendage Closure Are Important: Detection of Complications During Follow-up and How to Deal with Them

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