RESUMEN
The WATCHMAN™ atrial appendage closure device is designed to reduce the risk of stroke in patients with nonvalvular atrial fibrillation who are not suitable candidates for long-term oral anticoagulation therapy. However, the device also carries small risks, including procedural complications such as device migration, embolization, or pericardial effusion. We describe a case of WATCHMAN device migration requiring surgical retrieval.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Remoción de Dispositivos , Migración de Cuerpo Extraño , Humanos , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/terapia , Fibrilación Atrial/cirugía , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Resultado del Tratamiento , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Masculino , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Femenino , Anciano , Ecocardiografía Transesofágica , Diseño de PrótesisRESUMEN
Percutaneous left atrial appendage closure (LAAC) is a valid alternative to oral anticoagulation to prevent ischemic stroke in patients with atrial fibrillation.The devices approved in Europe and United States for percutaneous LAAC contain metal and temporary antithrombotic therapy is strongly recommended following implantation to prevent thrombus formation on the atrial device surface. There is still uncertainty regarding to the optimal antithrombotic drug regimen after device implantation for several reasons. Thus, this review aims at summarizing the available evidence and the remaining challenges related to the management of antithrombotic therapy in the context of LAAC procedure.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Fibrinolíticos , Humanos , Apéndice Atrial/cirugía , Fibrilación Atrial/complicaciones , Fibrilación Atrial/cirugía , Fibrinolíticos/uso terapéutico , Fibrinolíticos/administración & dosificación , Cateterismo Cardíaco/métodos , Dispositivo Oclusor Septal , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Accidente Cerebrovascular Isquémico/prevención & control , Trombosis/prevención & control , Trombosis/etiologíaAsunto(s)
Apéndice Atrial , Fibrilación Atrial , Humanos , Apéndice Atrial/cirugía , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Fibrilación Atrial/cirugía , Fibrilación Atrial/terapia , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Resultado del Tratamiento , Tomografía Computarizada por Rayos X , Dispositivo Oclusor Septal , Masculino , AncianoRESUMEN
INTRODUÇÃO: O fechamento percutâneo transcateter do apêndice atrial esquerdo surgiu recentemente como uma alternativa segura e eficaz à terapia anticoagulante de longo prazo na prevenção de AVC e na redução dos riscos de sangramento em pacientes com FA não valvular. No entanto, o papel da combinação do fechamento percutâneo transcateter do apêndice atrial esquerdo e ablação por cateter em um único procedimento ainda não está claro. OBJETIVOS: Neste estudo, os autores buscaram comparar a segurança do fechamento percutâneo transcateter do apêndice atrial esquerdo, ablação por cateter e o procedimento combinando-os em pacientes com fibrilação atrial. MÉTODOS: As bases de dados MEDLINE, EMBASE e a Cochrane Central foram revisadas sistematicamente em busca de estudos que relatassem o desfecho de complicações periprocedimentos na ablação por cateter e oclusão do apêndice atrial esquerdo em uma abordagem "one-stop". O procedimento combinado dessas abordagens, o fechamento percutâneo transcateter do apêndice atrial esquerdo e a ablação por cateter isoladamente foram analisados. Foi realizada uma metaanálise em rede bayesiana para estimar os efeitos relativos entre tratamentos utilizando razão de risco (RR) e para classificar cada um de acordo com a "Surface Under the Cumulative Ranking Curve" (SUCRA). RESULTADOS: Identificamos 11 ensaios relevantes representando 3343 participantes. A avaliação dos valores SUCRA indicou que apenas o LAAC (0,84) emergiu como o tratamento mais eficaz para a redução das complicações periprocedimento, seguido por apenas ablação (0,60) e abordagem combinada (0,05). O risco de complicações periprocedimento foi maior para o grupo apenas ablação (RR 0,73; intervalo credível [CrI] 0,45, 1,1) e menor para o grupo LAAC (RR 0,62; CrI 0,35, 1,0) quando comparados ao grupo combinado. Na comparação indireta entre os grupos LAAC apenas e ablação apenas, não houve significância estatística (Odds Ratio [OR] 1,1; CrI 0,27, 4,4; p=0,60). CONCLUSÃO: Nesta metanálise de rede, a abordagem combinada do fechamento percutâneo transcateter do apêndice atrial esquerdo e da ablação por cateter foi associada a um aumento de complicações periprocedimentos quando comparado aos procedimentos isoladamente. Portanto, deve-se avaliar cuidadosamente os benefícios e riscos de realizar esses procedimentos em conjunto, levando em consideração a segurança do paciente.
Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Apéndice Atrial , Metaanálisis en Red , Cierre del Apéndice Auricular Izquierdo , Accidente Cerebrovascular , HemorragiaRESUMEN
INTRODUÇÃO A mutação do fator V de Leiden é uma condição genética que acomete um ponto único no sítio de inativação do fator V impedindo a ligação com a proteína C ativada, resultando em um estado pró-trombótico. A fibrilação atrial (FA) é a arritmia mais comum do mundo com predomínio na população idosa, e está relacionada com elevado risco de eventos tromboembólicos. A oclusão do apêndice atrial esquerdo (OAA) é um procedimento minimamente invasivo, visando a tromboprofilaxia em pacientes com FA e contraindicação de anticoagulação oral (ACO). DESCRIÇÃO DO CASO Paciente M.S.F.R.S., octogenária com fragilidade severa, dependente para atividades básicas e instrumentais da vida diária, portadora da mutação heterozigótica do fator V de Leiden, dislipidêmica, ex-tagabista, obesidade sarcopênica e apresenta FA permanente em uso inicial de varfarina. Antecedentes de trombose venosa profunda em membro inferior direito, comunicação interatrial corrigida por atriosseptoplastia, quatro eventos prévios de acidente vascular encefálico (AVE) com sequela motora à direita, e osteoporose associado a múltiplas fraturas de vértebras com correção cirúrgica. Além disso, apresentava má adesão ao uso de varfarina com acompanhamento irregular do controle de INR, associado com episódios de sangramentos gastrointestinais. Por isso, optou-se pela realização da oclusão do apêndice atrial esquerdo para prevenção secundária de eventos tromboembólicos. A paciente fez uso de ácido acetilsalicílico (AAS) 100mg e clopidogrel 75mg durante 6 meses pós-procedimento, seguido da suspensão dessas medicações e introdução da rivaroxabana 15mg, devido ao risco elevado de eventos tromboembólicos propiciados pela trombofilia. Atualmente em uso de metoprolol 200mg/dia; digoxina 0,125mg/dia; omeprazol 20mg/dia; clonazepam 2mg/dia e rivaroxabana 15mg/dia. CONCLUSÃO Segundo ensaios clínicos randomizados, a OAA não mostrou-se inferior ao uso de ACO quanto a ocorrência de AVE e embolismo sistêmico, como também demonstrou superioridade quanto a menores taxas de mortalidade cardiovascular. O estudo PROTECT-AF recomenda o uso de ACO associado ao AAS por 45 dias, seguido da dupla antiagregação plaquetária durante 6 meses e após isso, uso indeterminado de AAS isolado. Porém a anticoagulação ideal pós-intervenção permanece um desafio. O futuro da OAA está relacionado com a experiência do operador, evolução da tecnologia dos dispositivos, consenso da terapia antitrombótica e manejo das principais complicações.
Asunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Fibrilación Atrial , Factor V , Apéndice Atrial , Arritmias Cardíacas , Ensayos Clínicos Controlados Aleatorios como Asunto , Accidente Cerebrovascular , Defectos del Tabique InteratrialAsunto(s)
Apéndice Atrial , Fibrilación Atrial , Cierre del Apéndice Auricular Izquierdo , Venas Pulmonares , Humanos , Apéndice Atrial/cirugía , Fibrilación Atrial/cirugía , Fibrilación Atrial/complicaciones , Ligadura/efectos adversos , Ligadura/métodos , Venas Pulmonares/cirugía , Cierre del Apéndice Auricular Izquierdo/efectos adversos , Cierre del Apéndice Auricular Izquierdo/métodosAsunto(s)
Apéndice Atrial , Accidente Cerebrovascular Isquémico , Tomografía Computarizada por Rayos X , Humanos , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/patología , Apéndice Atrial/fisiopatología , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/etiología , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/complicaciones , Fibrilación Atrial/fisiopatologíaRESUMEN
BACKGROUND: Left atrial appendage (LAA) slow-flow may increase the risk of ischemic stroke. We studied LAA attenuation on cardiac computed tomography in patients with acute ischemic stroke. METHODS AND RESULTS: We used data from a prospective cohort of patients with acute ischemic stroke undergoing cardiac computed tomography during the acute stroke imaging protocol. We compared characteristics, functional outcome (modified Rankin scale: higher scores indicating worse outcome), stroke recurrence and major adverse cardiovascular events after 2-year follow-up between patients with LAA thrombus (filling defect<100 Hounsfield Unit (HU)), slow-flow (filling defect ≥100 HU) and normal filling. Of 421 patients, 31 (7%) had LAA thrombus, 69 (16%) slow-flow, and 321 (76%) normal filling. Patients with thrombus or slow-flow more often had known atrial fibrillation compared with normal filling (45%, 39%, and 9%, P<0.001). Patients with thrombus had higher National Institutes of Health Stroke Scale-scores compared with slow-flow and normal filling (18 [interquartile range, 9-22], 6 [interquartile range, 3-17], and 5 [interquartile range, 2-11], P<0.001). Compared with normal filling, there was no difference with slow-flow in functional outcome (median modified Rankin scale, 3 versus 2; acOR 0.8 [95% CI, 0.5-1.4]), stroke recurrence (adjusted hazard ratio, 0.8 [95% CI, 0.3-1.9]) or major adverse cardiovascular events (adjusted hazard ratio, 1.2 [95% CI, 0.7-2.1]), while patients with thrombus had worse functional outcome (median modified Rankin scale, 6, acOR, 3.3 [95% CI, 1.5-7.4]). In cryptogenic stroke patients (n=156) slow-flow was associated with stroke recurrence (27% versus 6%, aHR, 4.1 [95% CI, 1.1-15.7]). CONCLUSIONS: Patients with slow-flow had similar characteristics to patients with thrombus, but had less severe strokes. Slow-flow was not significantly associated with functional outcome or major adverse cardiovascular events, but was associated with recurrent stroke in patients with cryptogenic stroke.
Asunto(s)
Apéndice Atrial , Accidente Cerebrovascular Isquémico , Humanos , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Masculino , Femenino , Anciano , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/fisiopatología , Accidente Cerebrovascular Isquémico/etiología , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Anciano de 80 o más Años , Factores de Riesgo , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/fisiopatología , Tomografía Computarizada por Rayos X , Fibrilación Atrial/complicaciones , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico por imagen , Factores de Tiempo , Valor Predictivo de las PruebasAsunto(s)
Apéndice Atrial , Fibrilación Atrial , Ablación por Catéter , Venas Pulmonares , Humanos , Apéndice Atrial/cirugía , Fibrilación Atrial/cirugía , Fibrilación Atrial/complicaciones , Ligadura/efectos adversos , Ligadura/métodos , Venas Pulmonares/cirugía , Cateterismo/efectos adversos , Cateterismo/instrumentaciónRESUMEN
BACKGROUND: Both atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases. If the two exist together, the risk of stroke, hospitalization for HF and all-cause death is increased. Currently, research on left atrial appendage closure (LAAC) in patients with AF and HF is limited and controversial. This study was designed to investigate the safety and effectiveness of LAAC in AF patients with different types of HF. METHODS: Patients with non-valvular atrial fibrillation (NVAF) and HF who underwent LAAC in the First Affiliated Hospital of Army Medical University from August 2014 to July 2021 were enrolled. According to left ventricular ejection fraction (LVEF), the study divided into HF with reduced ejection fraction (LVEF < 50%, HFrEF) group and HF with preserved ejection fraction (LVEF ≥ 50%, HFpEF) group. The data we collected from patients included: gender, age, comorbid diseases, CHA2DS2-VASc score, HAS-BLED score, NT-proBNP level, residual shunt, cardiac catheterization results, occluder size, postoperative medication regimen, transthoracic echocardiography (TTE) results and transesophageal echocardiography (TEE) results, etc. Patients were followed up for stroke, bleeding, device related thrombus (DRT), pericardial tamponade, hospitalization for HF, and all-cause death within 2 years after surgery. Statistical methods were used to compare the differences in clinical outcome of LAAC in AF patients with different types of HF. RESULTS: Overall, 288 NVAF patients with HF were enrolled in this study, including 142 males and 146 females. There were 74 patients in the HFrEF group and 214 patients in the HFpEF group. All patients successfully underwent LAAC. The CHA2DS2-VASc score and HAS-BLED score of HFrEF group were lower than those of HFpEF group. A total of 288 LAAC devices were implanted. The average diameter of the occluders was 27.2 ± 3.5 mm in the HFrEF group and 26.8 ± 3.3 mm in the HFpEF group, and there was no statistical difference between the two groups (P = 0.470). Also, there was no statistically significant difference in the occurrence of residual shunts between the two groups as detected by TEE after surgery (P = 0.341). LVEF was significantly higher in HFrEF group at 3 days, 3 months and 1 year after operation than before (P < 0.001). At 45-60 days after surgery, we found DRT in 9 patients and there were 4 patients (5.4%) in HFrEF group and 5 patients (2.3%) in HFpEF group, with no significant difference between the two groups (P = 0.357). One patient with DRT had stroke. The incidence of stroke was 11.1% in patients with DRT and 0.7% in patients without DRT (P = 0.670). There was one case of postoperative pericardial tamponade, which was improved by pericardiocentesis at 24 h after surgery in the HFpEF group, and there was no significant difference between the two groups (P = 1.000). During a mean follow-up period of 49.7 ± 22.4 months, there were no significant differences in the incidence of stroke, bleeding, DRT and HF exacerbation between the two groups. We found a statistical difference in the improvement of HF between HFrEF group and HFpEF group (P < 0.05). CONCLUSIONS: LAAC is safe and effective in AF patients with different types of HF. The improvement of cardiac function after LAAC is more pronounced in HFrEF group than in HFpEF group.
Asunto(s)
Fibrilación Atrial , Función del Atrio Izquierdo , Insuficiencia Cardíaca , Cierre del Apéndice Auricular Izquierdo , Accidente Cerebrovascular , Función Ventricular Izquierda , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Apéndice Atrial/cirugía , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/cirugía , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/cirugía , Cierre del Apéndice Auricular Izquierdo/efectos adversos , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Volumen Sistólico , Factores de Tiempo , Resultado del TratamientoRESUMEN
Atrial fibrillation poses significant stroke risks, particularly in patients undergoing cardiac surgery. Left atrial appendage occlusion has emerged as a crucial strategy for stroke prevention, garnering a Class I recommendation. This paper presents a technical framework for performing robotic left atrial appendage occlusion as an isolated procedure or concurrently with robotic coronary artery bypass grafting using the AtriCure AtriClip Pro2 device.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Puente de Arteria Coronaria , Procedimientos Quirúrgicos Robotizados , Accidente Cerebrovascular , Humanos , Apéndice Atrial/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Fibrilación Atrial/cirugía , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Puente de Arteria Coronaria/métodosRESUMEN
BACKGROUND: With the aim of reducing the risk of Cerebrovascular Accident (CVA) in patients with Non-Valvular Atrial Fibrillation (NVAF), Left Atrial Appendage Occlusion (LAAO) devices are emerging as an alternative to oral anticoagulants. OBJECTIVE: To analyze the efficacy and safety of the LAAO procedure in patients with NVAF and contraindications and/or failure for oral anticoagulants. METHOD: The search for evidence was carried out in the electronic databases Medline and Embase till January 2024. Additional searches were conducted on Google Scholar. The clinical trials registry database was also consulted. Two blinded investigators performed the search, study selection, and data collection, and assessed quality and risk of bias using the Cochrane tool for randomized clinical trials. Meta-analyses of eligible trials were performed using RevMan 5.4.1 software. The random effects model was used for all analyses. RESULTS: Five articles were selected, among which three were non-inferiority randomized clinical trials that analyzed the performance and safety of LAAO devices compared to the use of Vitamin K Antagonists (AVKs) or Novel Oral Anticoagulants (NOACs). No randomized clinical trials were found that analyzed populations with absolute contraindications to oral anticoagulants. Having as primary outcomes analyzed the occurrence of stroke (ischemic or hemorrhagic), cardiovascular or unexplained death and systemic embolism, the non-inferiority of the LAAO procedure compared to the use of oral anticoagulants was verified. CONCLUSIONS: For patients with an absolute contraindication to anticoagulation and/or failure to use oral anticoagulants, evidence for the use of LAAO devices is scarce.
Asunto(s)
Anticoagulantes , Apéndice Atrial , Fibrilación Atrial , Humanos , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/cirugía , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Apéndice Atrial/cirugía , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Resultado del Tratamiento , Administración Oral , Ensayos Clínicos Controlados Aleatorios como Asunto , Contraindicaciones de los Medicamentos , Cierre del Apéndice Auricular IzquierdoRESUMEN
PURPOSE: To assess the anatomical complexity of the left atrial appendage (LAA) using fractal dimension (FD) based on cardiac computed tomography angiography (CTA) and the association between LAA FD and LAA thrombosis. MATERIALS AND METHODS: Patients with atrial fibrillation (AF) who underwent both cardiac CTA and transesophageal echocardiography (TEE) between December 2018 and December 2022 were retrospectively analyzed. Patients were categorized into normal (n = 925), circulatory stasis (n = 82), and thrombus groups (n = 76) based on TEE results and propensity score matching (PSM) was performed for subsequent analysis. FD was calculated to quantify the morphological heterogeneity of LAA. Independent risk factors for thrombus were screened using logistic regression. The diagnostic performance of FD and CHA2DS2-VaSc score for predicting thrombus was evaluated using the area under the receiver operating characteristics curve (AUC). RESULTS: LAA FD was higher in the thrombus group (1.61 [1.49, 1.70], P < 0.001) than in the circulatory stasis (1.33 [1.18, 1.47]) and normal groups (1.30 [1.18, 1.42]) both before and after PSM. LAA FD was also an independent risk factor in the thrombus (OR [odds ratio] = 570,861.15 compared to normal, 41,122.87 compared to circulatory stasis; all P < 0.001) and circulatory stasis group (OR = 98.87, P = 0.001) after PSM. The diagnostic performance of LAA FD was significantly better than the CHA2DS2-VaSc score in identifying thrombus. CONCLUSIONS: Patients with high LAA FD are more likely to develop LAA thrombus, and the use of FD provides an effective method for assessing the risk of thrombosis in AF patients, thereby guiding individualized clinical treatment.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Ecocardiografía Transesofágica , Fractales , Trombosis , Humanos , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/complicaciones , Femenino , Masculino , Apéndice Atrial/diagnóstico por imagen , Estudios Retrospectivos , Persona de Mediana Edad , Trombosis/diagnóstico por imagen , Trombosis/etiología , Anciano , Ecocardiografía Transesofágica/métodos , Angiografía por Tomografía Computarizada/métodos , Factores de RiesgoRESUMEN
A 6-year-old boy had previously undergone total anomalous pulmonary venous connection repair and postoperative pulmonary vein stenosis release. Magnetic resonance imaging revealed blood stasis caused by a collision between the inflow from the pulmonary veins and the outflow from the left atrial appendage. A surgical specimen revealed evidence of advanced thrombus attachment. Infra-cardiac total anomalous pulmonary venous connection with an antler appearance may be a risk factor for thrombus formation in the left atrial appendage and for postoperative pulmonary venous stenosis due to blood flow collision in the left atrium after total anomalous pulmonary venous connection repair.
Asunto(s)
Venas Pulmonares , Trombosis , Humanos , Masculino , Niño , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/cirugía , Trombosis/fisiopatología , Resultado del Tratamiento , Venas Pulmonares/anomalías , Venas Pulmonares/cirugía , Venas Pulmonares/diagnóstico por imagen , Venas Pulmonares/fisiopatología , Síndrome de Cimitarra/cirugía , Síndrome de Cimitarra/diagnóstico por imagen , Síndrome de Cimitarra/fisiopatología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Imagen por Resonancia Magnética , Cardiopatías/diagnóstico por imagen , Cardiopatías/cirugía , Cardiopatías/etiología , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Atrios Cardíacos/anomalías , Estenosis de Vena Pulmonar/diagnóstico por imagen , Estenosis de Vena Pulmonar/etiología , Estenosis de Vena Pulmonar/cirugía , Estenosis de Vena Pulmonar/fisiopatología , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/anomalías , Apéndice Atrial/cirugía , Apéndice Atrial/fisiopatologíaRESUMEN
Cardiac compartmental size depends on sex, with smaller values found in (healthy) women compared to a matched group of men. Various types of heart disease may cause dilation of the affected chamber. For example, atrial fibrillation (AF) is associated with enlarged left atrial (LA) size, often also implying increased left ventricular (LV) size. Sex-specific differences appear to persist during disease states. Thus, chamber volumes depend on both sex and the severity of the underlying disorder, and require quantification to evaluate the effect of interventions. Often, we rely on the popular performance metric ejection fraction (EF) which refers to the ratio of the minimum and maximum LV or LA volumetric values observed during the cardiac cycle. Here we discuss a sex stratified analysis of LVEF and LAEF in AF patients as treated by LA appendage closure, while comparing those with or without device-related thrombosis. Also, an alternative analysis based on primary data is presented while emphasizing its attractiveness. In any event, age- and sex-specific reference values as broadly documented for various imaging modalities should be applied to LA and LV.
Asunto(s)
Fibrilación Atrial , Volumen Sistólico , Trombosis , Humanos , Volumen Sistólico/fisiología , Femenino , Masculino , Trombosis/fisiopatología , Trombosis/etiología , Fibrilación Atrial/fisiopatología , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatologíaRESUMEN
BACKGROUND: The prevalence of and outcomes associated with different antithrombotic strategies after left atrial appendage occlusion (LAAO) are not well described. OBJECTIVES: This study sought to evaluate patterns of antithrombotic medication strategies at discharge following LAAO with the Watchman FLX device in real-world practice and to compare the risk of adverse events among the different antithrombotic regimens. METHODS: The authors evaluated patients in the NCDR (National Cardiovascular Data Registry) LAAO Registry who underwent LAAO with the second-generation LAA closure device between 2020 and 2022. They grouped patients by mutually exclusive discharge antithrombotic strategies and compared the rates of adverse events at 45 days and 6 months using multivariable Cox proportional hazards regression. RESULTS: Among 53,878 patients undergoing successful LAAO with the second-generation LAA closure device, the most common antithrombotic discharge regimens were direct oral anticoagulant (DOAC) plus aspirin (48.3%), DOAC alone (22.6%), dual antiplatelet therapy (8.1%), warfarin plus aspirin (7.7%), and DOAC plus P2Y12 inhibitor (4.9%). In multivariate analysis, DOAC alone had a lower rate of major adverse events and major bleeding at 45 days of follow-up compared with DOAC plus aspirin (major adverse events: HR: 0.78; 95% CI: 0.68-0.91; major bleeding: HR: 0.69; 95% CI: 0.60-0.80). These differences persisted at 6 months. Warfarin without aspirin also showed lower rates of major bleeding at both time points. No differences were seen in stroke/transient ischemic attack or device-related thrombus. CONCLUSIONS: In real-world U.S. practice, discharge on DOAC alone or warfarin alone was associated with a lower rate of adverse events compared with DOAC plus aspirin.
Asunto(s)
Anticoagulantes , Aspirina , Apéndice Atrial , Fibrilación Atrial , Inhibidores de Agregación Plaquetaria , Humanos , Apéndice Atrial/cirugía , Masculino , Femenino , Aspirina/administración & dosificación , Aspirina/efectos adversos , Aspirina/uso terapéutico , Anciano , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/complicaciones , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Sistema de Registros , Anciano de 80 o más Años , Terapia Antiplaquetaria Doble/métodos , Quimioterapia Combinada , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/epidemiología , Persona de Mediana EdadAsunto(s)
Apéndice Atrial , Fibrilación Atrial , Fibrinolíticos , Humanos , Apéndice Atrial/cirugía , Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiologíaRESUMEN
BACKGROUND: The objective of this study is to investigate the incidence, potential risk factors, and clinical outcomes of incomplete device endothelialization (IDE) in atrial fibrillation (AF) patients undergoing Watchman left atrial appendage closure (LAAC). METHODS: In this study, 68 AF patients who underwent successful implantation of the Watchman device without peri-device leak (PDL) during follow-up were included. The endothelialization status was assessed using Transesophageal echocardiography (TEE) and LAA computed tomography angiography (CTA) at 6 weeks and 6 months post-implantation. Adverse cerebro-cardiac events were documented at one-year follow-up. Baseline characteristics, including age, device sizes, and clinical indicators, were analyzed as potential predictors for IDE. RESULTS: IDE was observed in 70.6% and 67.6% of patients at 6 weeks and 6 months after implantation, respectively. Higher levels of high-density lipoprotein cholesterol (HDL-C) [odds ratio (OR): 15.109, 95% confidence interval (CI): 1.637-139.478, p = 0.017 and OR: 11.015, 95% CI: 1.365-88.896, p = 0.024] and lower aspartate aminotransferase (AST) (OR 0.924, 95% CI: 0.865-0.986, p = 0.017 and OR: 0.930, 95% CI: 0.874-0.990, p = 0.023) at baseline were found to be significantly associated with IDE at 6 weeks and 6 months, respectively, although no significant difference in adverse cerebro-cardiac events was noted between incomplete and complete DE groups during 1-year follow-up CONCLUSIONS: IDE is found to be a prevalent occurrence in humans following LAAC. Elevated HDL-C and reduced AST levels are shown to be linked to an increased risk of IDE after LAAC.