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Outcomes of Amulet occluder implantation following Watchman screen failure in the ADVANCE LAA study: a real-world analysis of procedural success and safety.

AIMS: The Watchman device is widely used for left atrial appendage occlusion but may be unsuitable in patients with complex anatomies, resulting in screening failures. The Amulet occluder, with its dual-seal design, may overcome these limitations. The aim of this analysis is to evaluate procedural success, closure, and clinical outcomes of Amulet occluder implantation in patients who failed Watchman screening. METHODS AND RESULTS: This analysis from the ADVANCE LAA study included patients ineligible for Watchman (Screen Fail) compared to patients eligible for Amulet and Watchman (Device Eligi

Polymeric and metallic occluders for interventional therapy of cardiovascular diseases.

Interventional therapy has, as a minimally invasive approach, been widely adopted for treating cardiovascular diseases, particularly structural heart disease, where occluders play a pivotal role in transcatheter closure. This paper comprehensively reviews the evolutionary trajectory and emerging frontiers of cardiovascular occluders, beginning with their interventional applications in congenital heart defects (atrial septal defect, ventricular septal defect, patent foramen ovale, and patent ductus arteriosus) and left atrial appendage closure. The focus then shifts to occluder materials and de…

The use of percutaneous left atrial appendage occluder device in a patient with prior surgical ligation with incomplete exclusion: a case report.

BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and the most common cause of cardioembolic stroke. The left atrial appendage (LAA) is the main source of thrombus formation in patients with AF. Therapies include use of percutaneous LAA closure devices, or surgical LAA occlusion (LAAO). Despite these options, complete closure of the LAA is not always achieved, and residual communication between the LAA and atrium may result in increased thrombus formation. Although studies have analysed the use of percutaneous measures such as coils, plugs, or second occlude

One-stop procedure for persistent atrial fibrillation with cor triatriatum sinister under intracardiac echocardiography guidance: a case report.

This case report describes the treatment of a 76-year-old male patient diagnosed with persistent atrial fibrillation (AF) and cor triatriatu … cedure under intracardiac echocardiography (ICE) guidance, combining AF radiofrequency ablation and left atrial appendage closure (LAAC). Post-procedure recovery was uneventful, and follow-up transesophageal echocardiography showed no residual shunt or thrombus around the occluder. An antithrombotic regimen of rivaroxaban 15 mg once daily for three months followed by aspirin 1 …

Acute, periprocedural and longterm antithrombotic therapy in older adults: 2022 Update by the ESC Working Group on Thrombosis.

The first international guidance on antithrombotic therapy in the elderly came from the European Society of Cardiology Working Group on Thrombosis in 2015. This same group has updated its previous report on antiplatelet and anticoagulant drugs for older patients with acute or chronic coronary syndromes, atrial fibrillation, or undergoing surgery or procedures typical of the elderly (transcatheter aortic valve implantation and left atrial appendage closure). The aim is to provide a succinct but comprehensive tool for readers to understand the bases of antithrombotic therapy in older patients, d…

Arrhythmias and Device Therapies in Cardiac Amyloidosis.

Cardiac amyloidosis is caused by amyloid fibrils that deposit in the myocardial interstitium, causing restrictive cardiomyopathy and eventually death. The electromechanical, inflammatory, and autonomic changes due to amyloid deposition result in arrhythmias. Atrial fibrillation is by far the most common arrhythmia. The rate control strategy is generally poorly tolerated due to restrictive filling physiology and heart rate dependance, favoring adoption of the rhythm control strategy. Anticoagulation for stroke prophylaxis is warranted, irrespective of CHA2DS2-VASc score in patients with a favor

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… In the Cardiac Amyloidosis and Left Atrial Appendage Closure (CAMYLAAC) study, there were no significant differences in mortality between patients with and without CA (20% vs. 13.6%, p = 0.248) at the 2-year follow up. … Cardiac amyloidosis and left atrial appendage closure. The CAMYLAAC study Rev. Esp. Cardiol. Engl. Ed. 2023 76 503 510 10.1016/j.recesp.2022.07.011 35934294 47. Chen Y.Y. Kuo M.J. Chung F.P. Lin Y.J. Chien K.L. Hsieh Y.C. Chang S.L. Lo L.W. Hu Y.F. Chao T.F. …

Novel treatments for cardiovascular disease prevention.

The purpose of this review is to describe novel pharmacologic and nonpharmacologic preventive therapies, as well as new strategies to improv … latelet/thrombotic inhibition, lipid- and blood pressure-lowering; nonpharmacologic options such as left atrial appendage closure devices and caloric restriction; and strategies such as fixed-dose combination drugs, laboratory screening for drug tailoring, and community-based prevention programs. CVD preventive research continues to evolve and provide clinicians and patients w …

Interventions to prevent postoperative atrial fibrillation in Dutch cardiothoracic centres: a survey study.

INTRODUCTION: Postoperative atrial fibrillation (POAF) is a common phenomenon following cardiac surgery. In this study, we assessed current … icardial botulinum toxin type A injections). Usage of electrical cardioversions, anticoagulants and left atrial appendage closure were also enquired. RESULTS: Of the 15 centres, 14 (93%) responded to the survey and 13 reported a POAF incidence, ranging from 20 to 30%. Of these 14 centres, 6 prescribed preoperative AF prophylaxis to their patients, of which non-sotalol beta-bl …

Cryoablation for surgical treatment of chronic atrial fibrillation combined with mitral valve surgery: a clinical observation.

OBJECTIVE: Although the classical Cox-Maze III is the gold standard surgical therapy with a proven efficacy in the treatment of atrial fibri … tion with a newly designed N(2)O-based cryotherapy device. Pulmonary vein isolation with or without left atrial appendage closure (group A) was carried out in 65 cases and cryoablative bi-atrial Cox-Maze III (group B) in 25 patients. This additional procedure took only an extra 10 min for group A and about 20 min for group B. Half of the patients received a beta-blocker follow …

Usefulness of Echocardiography Contrast Agents for the Detection of Residual Leak After Percutaneous LAA Closure Device Implantation.

BACKGROUND: Residual leaks after percutaneous left atrial appendage closure (LAAC) are associated with an increase in thromboembolic events. Therefore, their detection and correction are crucial. CASE SUMMARY: This case was a 78-year-old woman with history of long-standing atrial fibrillation complicated by transient ischemic attack who underwent a percutaneous LAAC with a WATCHMAN device, with no residual leak. Initial follow-up transesophageal echocardiography (TEE) was unremarkable and anticoagulation therapy was stopped. Subsequent TEE was performed due to abnormal gap around the device n…

Same day discharge after structural heart disease interventions in the era of the coronavirus-19 pandemic and beyond.

With recent advancements in imaging modalities and techniques and increased recognition of the long-term impact of several structural heart disease interventions, the number of procedures has significantly increased. With the increase in procedures, also comes an increase in cost. In view of this, efficient and cost-effective methods to facilitate and manage structural heart disease interventions are a necessity. Same-day discharge (SDD) after invasive cardiac procedures improves resource utilization and patient satisfaction. SDD in appropriately selected patients has become the standard of ca

Influence of hospital volume and outcomes of adult structural heart procedures.

Hospital volume is regarded amongst many in the medical community as an important quality metric. This is especially true in more complicate … tral valve repair, septal ablation and septal myectomy for hypertrophic obstructive cardiomyopathy, left atrial appendage closure and atrial septal defect/patent foramen ovale closure. This is especially important since these structural heart interventions are relatively complex with evolving technology and a steep learning curve. The benefit was demonstrated both in lower mor …

Safety and effectiveness of catheter ablation of atrial fibrillation in patients with mitral valve replacement mechanical versus bioprosthetic valves.

This study aims to investigate if there is a difference in the safety and efficacy of catheter ablation of atrial fibrillation (AF) between patients with bioprosthetic mitral valve replacement (MVR) and those with mechanical MVR. A total of 23,794 patients who underwent the first-time catheter ablation of AF were screened. Patients with a history of surgical AF ablation, left atrial appendage closure, or resection were excluded from the study. There were 21 patients in the bioprosthetic MVR group and 85 patients in the mechanical MVR group were included in the study. After a median follow-up o…

Risk of atrial fibrillation in patients with multiple myeloma: what is known and directions for future study.

BACKGROUND: Multiple myeloma (MM) is a prevalent hematological tumor, and recent clinical data have highlighted the significance of atrial f … ailure on MM prognosis, as well as the influence of AF management methods like catheter ablation or left atrial appendage closure on MM prognosis. CONCLUSIONS: The supplementation of future data will provide more precise guidance for managing MM patients. By incorporating information regarding AF risk associated with MM treatment and examining the effects of AF management str …

Embolic Strokes in Paroxysmal Atrial Fibrillation: Anticoagulation Failure or Something Else?

Infective endocarditis (IE) often presents with various signs and/or symptoms. However, at times, IE can present without outstanding clinica … gulation failure (ACF), transesophageal echocardiography (TEE) was ordered to evaluate for possible left atrial appendage closure procedure, which disclosed a mobile, echo-bright structure on the mitral valve consistent with IE. Blood cultures returned positive, the patient was treated with IV antibiotics, and apixaban was resumed. It can be challenging to suspect IE clinicall …

The healing response of LAMax LAAC™ left atrial appendage occluder in a canine model: the potential influence of the implantation technique on the healing response.

BACKGROUND: Device-associated thrombus are potential causes for thromboembolic events post left atrial appendage closure (LAAC), and correlated with the complete endothelialization of the device surface. Our aim was to evaluate the endothelialization of LAMax LAAC™ occluder surface and analyze the potential influence of the implantation technique on the healing response. METHODS: A total of 29 healthy dogs (28.0 ± 3.7 kg) were implanted with the devices successfully after ensuring COVER signs was met (Concavity of the disc, Oversizing by 20-50%, Verifying position, Ensuring stability, Residua…

Use of Intracardiac Echocardiography in Interventional Cardiology: Working With the Anatomy Rather Than Fighting It.

The indications for catheter-based structural and electrophysiological procedures have recently expanded to more complex scenarios, in which … merging role in others, including mitral valvuloplasty, transcatheter aortic valve replacement, and left atrial appendage closure. In electrophysiology procedures, ICE allows integration of real-time images with electroanatomic maps; it has a role in assessment of arrhythmogenic substrate, and it is particularly useful for mapping structures that are not visualized by fluorosc …

Clinical management after surgical left atrial appendage exclusion.

BACKGROUND: Surgical left atrial appendage (LAA) closure is an increasingly utilized approach to mitigate the risk of cardioembolic stroke in patients with atrial fibrillation (AF). Consensus is lacking regarding optimal stroke prevention management after surgical LAA management. OBJECTIVE: To elucidate real world clinical management of anticoagulation in patients undergoing surgical LAA management. METHODS: Over a 7-year period at a single center, 458 participants carried a diagnosis of AF and underwent surgical exclusion of their LAA during concomitant cardiac surgery. Follow-up was catalo

Suspended Lead Suits and Radiation Exposure in Interventional Echocardiographers.

IMPORTANCE: Percutaneous left atrial appendage occlusion (LAAO) is frequently performed with an interventional echocardiographer (IE) in close proximity to the patient and radiation source, increasing the risk for occupational radiation exposure. Yet optimal radiation shielding methods for IEs remain unknown. OBJECTIVE: To assess whether using a suspended lead suit reduces IE radiation dose compared with traditional lead apron shielding during LAAO procedures. DESIGN, SETTING, AND PARTICIPANTS: In this blinded cross-sectional study, IE radiation exposure data were prospectively collected dur

Image-Based Medical Navigation Systems for Cardiac Interventions: Recent Technological Advances.

BACKGROUND: The application of catheter-based treatments for a growing range of structural heart diseases (SHD) has significantly increased … ew emphasizes that current multimodal imaging techniques enhance the accuracy of procedures such as left atrial appendage closure (LAAC), transcatheter aortic valve implantation (TAVI), and catheter ablation therapy. These techniques rely on combinations of imaging modalities such as fluoroscopy, ultrasound, and computed tomography (CT) to enable real-time guidance and precise …