scholarly journals Changes In Left Atrial Appendage Orifice Following Percutaneous Left Atrial Appendage Closure Using Three-Dimensional Echocardiography

2021 ◽  
Author(s):  
Xochitl Arely Ortiz-Leon ◽  
Edith Liliana Posada-Martinez ◽  
Alda Bregasi ◽  
Wanwen Chen ◽  
Ian Crandall ◽  
...  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Three Dimensional ◽  
Atrial Appendage ◽  
Maximum Diameter ◽  
Minimum Diameter ◽  
Eccentricity Index ◽  
Significant Difference ◽  
Watchman Device ◽  
Device Placement

Abstract Purpose: Percutaneous left atrial appendage (LAA) occlusion is increasingly performed in patients with atrial fibrillation and long-term contraindications for anticoagulation. Our aim was to evaluate the effects of LAA occlusion with the Watchman device on the geometry of the LAA orifice and assess its impact on the adjacent left upper pulmonary vein (LUPV) hemodynamics.Methods: We included 50 consecutive patients who underwent percutaneous LAA occlusion with the Watchman device. Three-dimensional images of LAA pre- and post-device placement were analyzed offline. We measured the LAA orifice diameters in the long axis, and the minimum and maximum diameters, circumference, and area in the short axis view. Eccentricity index was calculated as maximum/minimum diameter ratio. The LUPV peak S and D velocities pre- and post-procedure were also measured.Results: Patients were elderly (mean age 76±8 years years), 30 (60%) were men. There was a significant increase of all LAA orifice dimensions following LAA occlusion: diameter 1 (pre-device 18.1±3.2 vs. post-device 21.5±3.4 mm, p<0.001), diameter 2 (20.6±3.9 vs. 22.1±3.6 mm, p<0.001), minimum diameter (17.6±3.1 vs. 21.3±3.4 mm, p<0.001), maximum diameter (21.5±3.9 vs. 22.4±3.6 mm, p=0.022), circumference (63.6±10.7 vs. 69.6±10.5 mm, p<0.001), and area (3.1±1.1 vs. 3.9±1.2 cm2, p<0.001). Eccentricity index decreased after procedure (1.23±0.16 vs. 1.06±0.06, p<0.001). LUPV peak S and D velocities did not show a significant difference (0.29±0.15 vs. 0.30±0.14 cm/s, p=0.637; and 0.47±0.19 vs. 0.48±0.20 cm/s, p=0.549; respectively).Conclusion: LAA orifice stretches significantly and it becomes more circular following LAA occlusion without causing a significant impact on the LUPV hemodynamics.

scholarly journals A Comparative Study of Three Imaging Modalities for the Size Selection of Left Atrial Appendage Closure Device

2021 ◽  
Author(s):  
Zhong-bao Ruan ◽  
Fei Wang ◽  
Ge-cai Chen ◽  
Jun-guo Zhu ◽  
Yin Ren ◽  
...  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Imaging Modalities ◽  
Maximum Diameter ◽  
Left Atrial Appendage Closure ◽  
Limits Of Agreement ◽  
Depth Measurement ◽  
Significant Difference ◽  
Watchman Device

Abstract Background Accurate preprocedural measurements is important for left atrial appendage closure (LAAC). However, there were limited data comparing tomography angiography (CTA), trans-esophageal echocardiography (TEE) and digital subtraction angiography (DSA) for diagnostic accuracy and the utility for LAAC. This study aimed to compare the results of CTA, TEE and DSA measurements and analyze their accuracy, correlation and consistency in patients who successfully underwent LAAC.Methods 157 non-valvular atrial fibrillation (AF) patients who underwent LAAC were included. The maximum diameter and depth of LAA were recorded by CTA, TEE and DSA. Correlations and agreements were compared. Results All patients were successfully performed LAAC with Watchman device. There was no significant difference in the diameter measurement of LAA ostium between DSA and TEE. Meanwhile, The diameter of LAA ostium obtained by CTA was greater than that of DSA and TEE. There were good correlations between the LAA ostium measured by TEE, CTA, DSA and the Watchman device. DSA measurements and the actual device size were the widest limits of agreement, followed by TEE, CTA measurements were the narrowest limits of agreement. For the LAA depth measurements, mean CTA measurements was higher than that of TEE and DSA. There was no significant difference in the depth measurement among the three imaging modalities. Conclusions CTA, TEE and DSA measurements had good correlations with WATCHMAN device. The ostium diameter and depth of the LAA measured by CTA were greater than those measured by TEE and DSA. The relevance and concordance of CTA measurements were the best.

scholarly journals Troponin T Elevation After Percutaneous Left Atrial Appendage Occlusion

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoyan Wang ◽  
Xueying Chen ◽  
Yong Ye ◽  
Juan Peng ◽  
Jinyi Lin ◽  
...  
Keyword(s):  
Exposure Time ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Troponin T ◽  
Atrial Appendage ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Damage ◽  
Left Atrial Appendage Occlusion ◽  
Significant Difference ◽  
Watchman Device

Background: Cardiac troponin T (cTNT) has been widely used in detecting cardiac damage. Elevated cTNT level has been reported to be associated with increased mortality in multiple cardiac conditions. It is not uncommon to observe an increased level of cTNT in patients after left atrial appendage occlusion (LAAO). The objective of the study is to study the incidence, significance, and factors associated with cTNT elevation after LAAO.Methods: We prospectively included patients who underwent LAAO from January 2019 to July 2020 in Fudan Zhongshan Hospital. Patients were divided into those with elevated cTNT after procedure and those with normal postprocedure cTNT. All individuals were followed up for 1 year. The primary outcome is major adverse cardiovascular events, which include myocardial infarction, heart failure, cardiac death, and stroke. The second outcome is periprocedure complication, including chest pain, tachycardia, cardiac tamponade, change of electrocardiograph, and atrial thrombus.Results: A total of 190 patients were enrolled. Of the patients, 85.3% had elevated cTNT after LAAO, while 14.7% of them did not. Exposure time, dosage of contrast, types of devices, shapes, and sizes of LAA could contribute to elevated postprocedure cTNT. We found that patients with a Watchman device were more likely to have elevated postprocedure cTNT than those with a Lambre device (89.2 vs. 76.7%, p = 0.029). LAAO shapes were associated with cTNT levels in patients with a Watchman device, while the diameter of the outer disc and LAA depth mattered for the Lambre device. There was no significant difference in the primary and second outcome between the two groups (p-value: 0.619, 0.674).Conclusion: LAAO was found to be commonly accompanied with cTNT elevation, which might not to be related to the complications and adverse cardiac outcomes within 1 year of follow-up. Moreover, eGFR at baseline, exposure time, dosage of contrast, types of LAAO device, and LAA morphology could contribute to cTNT elevation.

scholarly journals Antithrombotic Dilemmas after Left Atrial Appendage Occlusion Watchman Device Placement

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Tania Ahuja ◽  
Scarlett Murphy ◽  
Daniel J. Sartori
Keyword(s):  
Antithrombotic Therapy ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion ◽  
Device Implantation ◽  
Watchman Device ◽  
Device Placement

Antithrombotic therapy for stroke prevention in patients with atrial fibrillation (AF) has dramatically shifted from warfarin, a vitamin K antagonist, to the direct oral anticoagulants (DOACs) such as dabigatran, apixaban, and rivaroxaban. In patients with contraindications to oral anticoagulation, left atrial appendage occlusion (LAAO) devices, such as the Watchman™ device, may be considered; however, temporary postimplantation antithrombotic therapy is still a recommended practice. We present a case of complex antithrombotic management, post LAAO device implantation, designed to avoid drug interactions with concomitant rifampin use and remained necessary secondary to subsequent device leak. This case highlights the challenges of antithrombotic therapy post LAAO device placement in a complex, but representative, patient.

Abstract 13572: The Effects of Baseline Thrombocytopenia on Post-procedural Bleeding and Thrombotic Outcomes of Left Atrial Appendage Closure With Watchman Device

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Chiehju Chao ◽  
Chia-chun Chiang ◽  
Pradyumna Agasthi ◽  
Marlene Girardo ◽  
Reza Arsanjani ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Therapeutic Option ◽  
Bleeding Risk ◽  
Atrial Appendage ◽  
Outcome Analysis ◽  
Significant Difference ◽  
Watchman Device ◽  
The Mean

Background: Left atrial appendage occlusion (LAAO) devices have successfully provided an alternative therapeutic option in patients with atrial fibrillation and high bleeding risk. However, patients with thrombocytopenia (TP) were underrepresented in the milestone trials, and the optimal strategy of postprocedural antithrombotic therapy in this group of patients remains unclear. Methods: Patients were identified from the National Cardiac Database Registry - LAAO database at all three Mayo Clinic sites in the period from 1/2016-10/2019. Patients were further divided into TP (platelet &lt; 150 x 10^9/L) and control (platelet &gt; 150 x 10^9 /L) groups for clinical outcome analysis. Outcome endpoints include composite of bleeding (GI bleeding, hemorrhagic stroke, and other non-intracranial hemorrhage) and composite thrombotic events (device thrombus, ischemic stroke, TIA and undetermined stroke). Results: A total of 249 consecutive patients were included in the final analysis. The mean age was 76.7 ± 7.2 years, and 169 (67.9%) were male; 242 (97.2%) were white. The mean CHA2DS2-VASc score was 5.3 ±1.5, and the HAS-BLED score was 3.0 ± 1.1. TP at baseline was present in 74 (29.7%) patients. The median follow-up time was 6.8 months. The use of post-procedural antithrombotic regimens was similar between the two groups (Table 1). When comparing the TP group to control, there was no significant difference in composite bleeding events (10.8% vs. 8.0%, P = 0.069) and thrombotic events (2.7% vs. 2.3%, P= 0.170). Conclusions: The presence of baseline TP does not significantly increase post-procedural bleeding risk in atrial fibrillation/atrial flutter patients who underwent an LAAO occlusion procedure with the Watchman device (Boston Scientific). This group of patients can be treated with the same antithrombotic regimen as patients with normal platelet levels. Future studies are still warranted to determine the optimal antithrombotic regimen.

scholarly journals PERIDEVICE LEAK AND DEVICE SIZING IN PATIENTS RECEIVING LEFT ATRIAL APPENDAGE CLOSURE WITH THE WATCHMAN DEVICE

2021 ◽  
Vol 77 (18) ◽  
pp. 955
Author(s):  
Lauren Sharan Ranard ◽  
Elena Donald ◽  
Shmuel Chen ◽  
Omar Khalique ◽  
Nadira Hamid ◽  
...  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure ◽  
Watchman Device

scholarly journals Safety and effects of volume loading during transesophageal echocardiography in the pre-procedural work-up for left atrial appendage closure

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Afonso B. Freitas-Ferraz ◽  
Mathieu Bernier ◽  
Kim O’Connor ◽  
Jonathan Beaudoin ◽  
Jean Champagne ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Maximum Diameter ◽  
Volume Loading ◽  
Fluid Bolus ◽  
Work Up ◽  
Device Size ◽  
Laa Closure

Abstract Background In patients undergoing left atrial appendage (LAA) closure, an accurate sizing of the LAA is key to optimize device sizing, procedural success and reduce complications. Previous studies have shown that intraprocedural volume loading increases LAA dimensions and improves device sizing. However, the safety and effects on LAA and device sizing of administering a fluid bolus during pre-procedural transesophageal echocardiography (TEE) are unknown. The aim of this study was to determine the safety and impact on LAA dimensions and device sizing of an intravenous (IV) fluid bolus administered during TEE in the setting of the pre-procedural work-up for LAA closure. Methods The study included a total of 72 patients who underwent TEE to assess suitability for LAAC and received a 500 ml IV bolus of normal saline. The LAA landing zone (LZ) and depth were measured by TEE before and after volume loading, and these measurements were used to predict the device size implanted during a subsequent percutaneous LAAC procedure. Results There were no complications associated with volume loading. The baseline mean LZ was 19.6 ± 3.6 mm at 90o, and 20.2 ± 4.1 mm at 135o. Following fluid bolus, the maximum diameter increased 1.5 ± 1.0 mm at 90o (p<0.001), and 1.3 ± 1.0 mm at 135o (p<0.001). The baseline mean depth of the LAA was 26.5 ± 5.5 mm at 90o, and 23.9 ± 5.8 mm at 135o. After fluid bolus, the mean depth increased by 1.5 ± 1.8 mm (p<0.001) and 1.6 ± 2.0 (p<0.001), at 90o and 135o, respectively. Sizing based on post-bolus measurements of the LZ significantly improved the agreement with the final device size selection during the procedure in 71.0% of cases (vs. 42.0% with pre-bolus measurements). Conclusions Volume loading during ambulatory TEE as part of the pre-procedural work-up of LAAC is safe and significantly increases LAA dimensions. This strategy may become the new standard, particularly in centers performing LAAC with no TEE guidance, as it improves LAA sizing and more accurately predicts the final device size.

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