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 Prótesis

Asunto(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 , Anciano

Asunto(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/fisiopatología

RESUMEN

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 Pruebas

RESUMEN

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 Tratamiento

RESUMEN

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 Riesgo

RESUMEN

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/fisiopatología

RESUMEN

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/fisiopatología

Asunto(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/etiología

RESUMEN

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.

Asunto(s)

Apéndice Atrial , Fibrilación Atrial , Cateterismo Cardíaco , Ecocardiografía Transesofágica , Humanos , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/epidemiología , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/cirugía , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Masculino , Femenino , Anciano , Factores de Riesgo , Incidencia , Persona de Mediana Edad , Resultado del Tratamiento , Factores de Tiempo , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Angiografía por Tomografía Computarizada , Medición de Riesgo , Anciano de 80 o más Años , Cierre del Apéndice Auricular Izquierdo

Asunto(s)

Apéndice Atrial , Cateterismo Cardíaco , Insuficiencia de la Válvula Mitral , Válvula Mitral , Humanos , Apéndice Atrial/cirugía , Apéndice Atrial/fisiopatología , Apéndice Atrial/diagnóstico por imagen , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Insuficiencia de la Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/fisiopatología , Válvula Mitral/cirugía , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Resultado del Tratamiento , Implantación de Prótesis de Válvulas Cardíacas/métodos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Fibrilación Atrial/cirugía , Fibrilación Atrial/complicaciones , Fibrilación Atrial/terapia

RESUMEN

Left atrial appendage occlusion (LAAO) is rapidly growing as valid stroke prevention therapy in atrial fibrillation. Cardiac imaging plays an instrumental role in preprocedural planning, procedural execution, and postprocedural follow-up. Recently, cardiac computed tomography (CCT) has made significant advancements, resulting in increasing use both preprocedurally and in outpatient follow-up. It provides a noninvasive, high-resolution alternative to the current standard, transesophageal echocardiography, and may display advantages in both the detection and characterization of device-specific complications, such as peridevice leak and device-related thrombosis. The implementation of CCT in the follow-up after LAAO has identified new findings such as hypoattenuated thickening on the atrial device surface and left atrial appendage contrast patency, which are not readily assessable on transesophageal echocardiography. Currently, there is a lack of standardization for acquisition and interpretation of images and consensus on definitions of essential findings on CCT in the postprocedural phase. This paper intends to provide a practical and standardized approach to both acquisition and interpretation of CCT after LAAO based on a comprehensive review of the literature and expert consensus among European and North American interventional and imaging specialists.

Asunto(s)

Apéndice Atrial , Fibrilación Atrial , Cateterismo Cardíaco , Consenso , Valor Predictivo de las Pruebas , Accidente Cerebrovascular , Tomografía Computarizada por Rayos X , Humanos , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/terapia , Fibrilación Atrial/fisiopatología , Resultado del Tratamiento , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/normas , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Factores de Riesgo , Ecocardiografía Transesofágica

Asunto(s)

Anticoagulantes , Apéndice Atrial , Fibrilación Atrial , Cateterismo Cardíaco , Contraindicaciones de los Medicamentos , Insuficiencia del Tratamiento , Humanos , Apéndice Atrial/fisiopatología , Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Anticoagulantes/efectos adversos , Anticoagulantes/administración & dosificación , Factores de Riesgo , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Medición de Riesgo , Hemorragia/inducido químicamente , Toma de Decisiones Clínicas , Femenino , Anciano , Masculino , Selección de Paciente

Asunto(s)

Anticoagulantes , Apéndice Atrial , Fibrilación Atrial , Contraindicaciones de los Medicamentos , Humanos , Apéndice Atrial/fisiopatología , Apéndice Atrial/diagnóstico por imagen , Anticoagulantes/efectos adversos , Anticoagulantes/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Factores de Riesgo , Insuficiencia del Tratamiento , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Medición de Riesgo , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Toma de Decisiones Clínicas , Selección de Paciente , Hemorragia/inducido químicamente

RESUMEN

CONTEXT: Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography. AIMS: Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice. SETTINGS AND DESIGN: Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry. MATERIAL AND METHODS: Retrospective data analysis from 2017-2021. STATISTICAL ANALYSIS USED: Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher's exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics. RESULTS: A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03-0.80, P = 0.0261). CONCLUSIONS: While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. Anesthetic management for LAAC varies with geographic location.

Asunto(s)

Anestesia General , Apéndice Atrial , Fibrilación Atrial , Cateterismo Cardíaco , Sistema de Registros , Humanos , Apéndice Atrial/cirugía , Apéndice Atrial/diagnóstico por imagen , Masculino , Femenino , Estudios Retrospectivos , Anciano , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/estadística & datos numéricos , Fibrilación Atrial/cirugía , Anestesia General/métodos , Anestesia General/estadística & datos numéricos , Estados Unidos , Anciano de 80 o más Años , Persona de Mediana Edad , Ecocardiografía Transesofágica/métodos , Resultado del Tratamiento , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/epidemiología

RESUMEN

A patient presenting with acute ischemic stroke associated with patent foramen ovale (PFO) had concurrent deep vein thrombosis, pulmonary embolism, and new-onset atrial fibrillation. Upon initiation of anticoagulation therapy, the patient developed hemorrhagic transformation of the stroke. The patient's multiple potential sources of embolic stroke were treated with concomitant left atrial appendage occlusion and PFO closure through the PFO, made possible by using the Steerable Amulet Sheath under 3D-intracardiac echocardiography guidance.

Asunto(s)

Apéndice Atrial , Cateterismo Cardíaco , Ecocardiografía Tridimensional , Foramen Oval Permeable , Humanos , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/terapia , Foramen Oval Permeable/complicaciones , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Resultado del Tratamiento , Accidente Cerebrovascular Isquémico/etiología , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Ultrasonografía Intervencional , Masculino , Dispositivo Oclusor Septal , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/terapia , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/complicaciones , Anciano , Accidente Cerebrovascular Embólico/etiología , Accidente Cerebrovascular Embólico/prevención & control , Accidente Cerebrovascular Embólico/diagnóstico por imagen , Femenino , Ecocardiografía Transesofágica , Persona de Mediana Edad

Asunto(s)

Apéndice Atrial , Fibrilación Atrial , Cateterismo Cardíaco , Ecocardiografía Transesofágica , Valor Predictivo de las Pruebas , Humanos , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/terapia , Cateterismo Cardíaco/instrumentación , Resultado del Tratamiento , Ultrasonografía Intervencional , Diseño de Equipo , Masculino , Anciano , Femenino , Transductores

RESUMEN

BACKGROUND: Patients treated with left atrial appendage occlusion (LAAO) are at high bleeding risk. Intensive antithrombotic treatment is recommended after the procedure to prevent device-related thrombosis. OBJECTIVES: This study sought to evaluate the incidence, consequences, and predictors of early nonprocedural bleeding after LAAO. METHODS: This was a multicenter study including 1,649 patients undergoing LAAO in 9 centers. Early nonprocedural bleeding was defined as bleeding unrelated to the procedure occurring within 3 months after device implantation. The severity of bleeding was defined by the Valve Academic Research Consortium-2 classification. A sensitivity analysis was performed at 45 days. RESULTS: A total of 121 (7.3%) patients experienced early nonprocedural bleeding events, and 69 (57.0%) were classified as major bleeding (4.2% of patients). Independent predictors of early nonprocedural bleeding were dual antiplatelet therapy (DAPT) at discharge (adjusted HR [aHR]: 1.61; 95% CI: 1.12-2.33; P = 0.01), prior gastrointestinal bleeding (aHR: 2.15; 95% CI: 1.38-3.35; P < 0.001), and multiple locations of prior bleeding (aHR: 2.33; 95% CI: 1.34-4.05; P < 0.001). DAPT at discharge was predictive of both all and major nonprocedural bleeding at 3 months and 45 days. After a median follow-up of 2.3 years (Q1-Q3: 1.1-4.1 years), early nonprocedural bleeding was independently associated with an increased risk of all-cause death (aHR: 1.53; 95% CI: 1.15-2.06; P < 0.001). This heightened mortality risk was similar at 45 days. CONCLUSIONS: Early nonprocedural bleeding after LAAO occurred in ∼7% of patients within 3 months, with more than one-half being classified as major bleeding. Regardless of severity, early nonprocedural bleeding was associated with increased mortality. DAPT at discharge determined an increased risk of early nonprocedural bleeding after LAAO. These results emphasize the importance of bleeding risk for determining antithrombotic strategies after LAAO.

Asunto(s)

Apéndice Atrial , Fibrilación Atrial , Cateterismo Cardíaco , Hemorragia , Inhibidores de Agregación Plaquetaria , Humanos , Apéndice Atrial/fisiopatología , Apéndice Atrial/diagnóstico por imagen , Masculino , Femenino , Anciano , Factores de Riesgo , Factores de Tiempo , Fibrilación Atrial/mortalidad , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/complicaciones , Resultado del Tratamiento , Medición de Riesgo , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Hemorragia/etiología , Incidencia , Anciano de 80 o más Años , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/mortalidad , Terapia Antiplaquetaria Doble/efectos adversos , Estados Unidos/epidemiología , Persona de Mediana Edad , Fibrinolíticos/efectos adversos , Fibrinolíticos/administración & dosificación , Estudios Retrospectivos , Europa (Continente) , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación

Asunto(s)

Apéndice Atrial , Fibrilación Atrial , Cateterismo Cardíaco , Humanos , Apéndice Atrial/fisiopatología , Apéndice Atrial/diagnóstico por imagen , Resultado del Tratamiento , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/terapia , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Factores de Riesgo , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Factores de Tiempo , Cierre del Apéndice Auricular Izquierdo

RESUMEN

AIMS: To investigate the relationship between left atrial appendage (LAA) morphology, quantified based on fractal dimension (FD), and LAA hemodynamic parameters in patients with atrial fibrillation (AF), in an effort to reveal the effect of LAA shape on blood flow. MATERIALS AND METHODS: 225 patients with AF who underwent cardiac computed tomography angiography (CTA) and transesophageal echocardiography (TEE) were enrolled. LAA morphology was quantified based on FD on cardiac CTA images, and LAA hemodynamic parameters, including injection fraction (EF), filling peak flow velocity (FV), maximum speed of emptying (PEV), and wall motion velocity (WMV), were assessed using TEE. RESULTS: We divided the patients with AF into two groups based on a mean LAA FD of 1.32: the low FD group (n=124) and the high FD group (n=101). Compared to the low FD group, there were more patients with LAA circulatory stasis/thrombus (P=0.008) in the high FD group, as well as lower LAA FV (P=0.004), LAA PEV (P=0.007), and LAA WMV (P=0.007). LAA FD was an independent and significant determinant of LAA EF (ß = -11.755, P=0.001), LAA FV (ß = -17.364, P=0.004), LAA PEV (ß = -18.743, P<0.001), and LAA WMV (ß = -7.740, P=0.001) in multiple linear regression analysis. CONCLUSIONS: LAA FD is an essential determinant of LAA hemodynamic parameters, suggesting that the relatively complex morphology of the LAA may influence its hemodynamics, which can correlate with embolic events.

Asunto(s)

Apéndice Atrial , Fibrilación Atrial , Angiografía por Tomografía Computarizada , Ecocardiografía Transesofágica , Fractales , Hemodinámica , Humanos , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/fisiopatología , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Femenino , Masculino , Hemodinámica/fisiología , Anciano , Ecocardiografía Transesofágica/métodos , Angiografía por Tomografía Computarizada/métodos , Persona de Mediana Edad , Estudios Retrospectivos