Endocardial versus epicardial left atrial appendage exclusion for stroke prevention in patients with atrial fibrillation: Midterm follow‐up

2020 ◽  
Author(s):  
Radoslaw Litwinowicz ◽  
Marian Burysz ◽  
Piotr Mazur ◽  
Boguslaw Kapelak ◽  
Magdalena Bartus ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage

Outcome of left atrial appendage occlusion in high-risk patients

Heart ◽  
2017 ◽  
Vol 104 (7) ◽  
pp. 594-599 ◽  
Author(s):  
Ahmed Masoud ◽  
Stefano Bartoletti ◽  
Timothy Fairbairn ◽  
Ayush Khurana ◽  
Periaswamy Velavan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Events ◽  
Stroke Prevention ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Complication Rates ◽  
Serious Adverse Events ◽  
Risk Patients

ObjectivePercutaneous left atrial appendage (LAA) occlusion can be an interventional alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation.MethodsWe delivered LAA occlusion therapy using a standardised approach to patient referral, multidisciplinary team assessment, implant criteria, imaging and follow-up. We analysed patient characteristics, efficacy and safety of the implant procedure, and 12-month outcomes.ResultsOf 143 referrals from October 2014 to December 2016, 83 patients (age 76±8years, 32.5% female, mean CHAD2S2-VASc score 4 ±1) were offered LAA occlusion. Eighty (95.3%) had previous major bleeding (intracranial in 59%). LAA occluder implantation with an Amulet device was successful in 82 (98.8%), with periprocedural major adverse events occurring in 5 (6.0%) patients (2 device embolisations including 1 death, 2 major bleeds). Cardiac imaging in 75 (94%) patients 2months following implant showed device-related thrombus in 1 case (1.3%) and minor (<5mm) device leaks in 13 (17.1%). Over a median 12-month follow-up, 3 (3.8%) ischaemic strokes, 2 (2.5%) haemorrhagic strokes and 5 (6.3%) major extracranial bleeds occurred. All-cause mortality was 10%, with most deaths (7, 87.5%) due to non-cardiovascular causes.ConclusionsLAA occlusion may be a reasonable option for stroke prevention inhigh-risk patients with atrial fibrillation ineligible for anticoagulation. However, procedural complication rates are not insignificant, and patients remain at risk of serious adverse events and death even after successful implant.

scholarly journals Spontaneously occluded left atrial appendage in a patient with atrial fibrillation and stroke: a case report

2020 ◽  
Vol 4 (2) ◽  
pp. 1-4
Author(s):  
Andreas Bugge Tinggaard ◽  
Kasper Korsholm ◽  
Jesper Møller Jensen ◽  
Jens Erik Nielsen-Kudsk
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Transoesophageal Echocardiography ◽  
Similar Efficacy ◽  
Cardiovascular Death ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion ◽  
All Cause Mortality

Abstract Background  The left atrial appendage (LAA) is the main source of thromboembolism in atrial fibrillation (AF). Transcatheter closure is non-inferior to warfarin therapy in preventing stroke. Case summary  A patient with two consecutive strokes associated with AF was referred for transcatheter LAA occlusion (LAAO). Preprocedural cardiac CT and transoesophageal echocardiography demonstrated a spontaneously occluded LAA with a smooth left atrial surface, with stationary results at 6- and 12-month imaging follow-up. Warfarin was discontinued, and life-long aspirin instigated. Discussion  Left atrial appendage occlusion has shown non-inferiority to warfarin for prevention of stroke, cardiovascular death, and all-cause mortality. No benefits from anticoagulation have been demonstrated in patients with embolic stroke of undetermined source. In the present case, we observed that the LAA was occluded and, therefore, treated with aspirin monotherapy assuming similar efficacy as transcatheter LAAO.

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