scholarly journals Left Atrial Appendage: Physiology, Pathology, and Role as a Therapeutic Target

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Damiano Regazzoli ◽  
Francesco Ancona ◽  
Nicola Trevisi ◽  
Fabrizio Guarracini ◽  
Andrea Radinovic ◽  
...  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Blood Stasis ◽  
Atrial Appendage ◽  
Low Flow ◽  
Left Atrial Appendage Occlusion ◽  
Poor Patient Compliance ◽  
Increased Risk ◽  
Variable Morphology

Atrial fibrillation (AF) is the most common clinically relevant cardiac arrhythmia. AF poses patients at increased risk of thromboembolism, in particular ischemic stroke. The CHADS2 and CHA2DS2-VASc scores are useful in the assessment of thromboembolic risk in nonvalvular AF and are utilized in decision-making about treatment with oral anticoagulation (OAC). However, OAC is underutilized due to poor patient compliance and contraindications, especially major bleedings. The Virchow triad synthesizes the pathogenesis of thrombogenesis in AF: endocardial dysfunction, abnormal blood stasis, and altered hemostasis. This is especially prominent in the left atrial appendage (LAA), where the low flow reaches its minimum. The LAA is the remnant of the embryonic left atrium, with a complex and variable morphology predisposing to stasis, especially during AF. In patients with nonvalvular AF, 90% of thrombi are located in the LAA. So, left atrial appendage occlusion could be an interesting and effective procedure in thromboembolism prevention in AF. After exclusion of LAA as an embolic source, the remaining risk of thromboembolism does not longer justify the use of oral anticoagulants. Various surgical and catheter-based methods have been developed to exclude the LAA. This paper reviews the physiological and pathophysiological role of the LAA and catheter-based methods of LAA exclusion.

scholarly journals Double-blind, placebo-controlled randomised clinical trial to evaluate the effect of ASPIRIN discontinuation after left atrial appendage occlusion in atrial fibrillation: protocol of the ASPIRIN LAAO trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044695
Author(s):  
Mu Chen ◽  
Qunshan Wang ◽  
Jian Sun ◽  
Peng-Pai Zhang ◽  
Wei Li ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Ethics Committee ◽  
Aspirin Therapy ◽  
Atrial Appendage ◽  
Control Group ◽  
Coronary Syndrome ◽  
Left Atrial Appendage Occlusion ◽  
Increased Risk

IntroductionIt is the common clinical practice to prescribe indefinite aspirin for patients with non-valvular atrial fibrillation (NVAF) post left atrial appendage occlusion (LAAO). However, aspirin as a primary prevention strategy for cardiovascular diseases has recently been challenged due to increased risk of bleeding. Therefore, aspirin discontinuation after LAAO in atrial fibrillation (ASPIRIN LAAO) trial is designed to assess the uncertainty about the risks and benefits of discontinuing aspirin therapy at 6 months postimplantation with a Watchman LAAO device in NVAF patients.Methods and analysisThe ASPIRIN LAAO study is a prospective, multicentre, randomised, double-blinded, placebo-controlled non-inferiority trial. Patients implanted with a Watchman device within 6 months prior to enrollment and without pre-existing conditions requiring long-term aspirin therapy according to current guidelines are eligible for participating the trial. Subjects will be randomised in a 1:1 allocation ratio to either the Aspirin group (aspirin 100 mg/day) or the control group (placebo) at 6 months postimplantation. A total of 1120 subjects will be enrolled from 12 investigational sites in China. The primary composite endpoint is stroke, systemic embolism, cardiovascular/unexplained death, major bleeding, acute coronary syndrome and coronary or periphery artery disease requiring revascularisation at 24 months. Follow-up visits are scheduled at 6 and 12 months and then every 12 months until 24 months after the last patient recruitment.Ethics and disseminationEthics approval was obtained from the Ethics Committee of Xinhua Hospital, Shanghai, China (reference number XHEC-C-2018-065-5). The protocol is also submitted and approved by the institutional Ethics Committee at each participating centre. Results are expected in 2024 and will be disseminated through peer-reviewed journals and presentations at national and international conferences.Trial registration numberNCT03821883.

Comparative data on left atrial appendage occlusion efficacy and clinical outcomes by age group in the Amplatzer™ Amulet™ Occluder Observational Study

EP Europace ◽  
2020 ◽  
Author(s):  
Xavier Freixa ◽  
Boris Schmidt ◽  
Patrizio Mazzone ◽  
Sergio Berti ◽  
Sven Fischer ◽  
...  
Keyword(s):  
Observational Study ◽  
Ischaemic Stroke ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Serious Adverse Events ◽  
Left Atrial Appendage Occlusion ◽  
Increased Risk ◽  
The Impact

Abstract Aims Left atrial appendage occlusion (LAAO) may be considered for patients with non-valvular atrial fibrillation (NVAF) and a relative/formal contraindication to anticoagulation. This study aimed to summarize the impact of aging on LAAO outcomes at short and long-term follow-up. Methods and results We compared subjects aged <70, ≥70 and <80, and ≥80 years old in the prospective, multicentre Amplatzer™ Amulet™ Occluder Observational Study (Abbott, Plymouth, MN, USA). Serious adverse events (SAEs) were reported from implant through a 2-year post-LAAO visit and adjudicated by an independent clinical events committee. Overall, 1088 subjects were prospectively enrolled. There were 265 subjects (24.4%) <70 years old, 491 subjects (45.1%) ≥70 and <80 years old, and 332 subjects (30.5%) ≥80 years old, with the majority (≥80%) being contraindicated to anticoagulation. As expected, CHA2DS2-VASc and HAS-BLED Scores increased with age. Implant success was high (≥98.5%) across all groups, and the proportion of subjects with a procedure- or device-related SAE was similar between groups. At follow-up, the observed ischaemic stroke rate was not significantly different between groups, and corresponding risk reductions were 62, 56, and 85% when compared with predicted rates for subjects <70, ≥70 and <80, and ≥80 years old, respectively. Major bleeding and mortality rates increased with age, while the incidence of device-related thrombus tended to increase with age. Conclusions Despite the increased risk for ischaemic stroke with increasing age in AF patients, LAAO reduced the risk for ischaemic stroke compared with the predicted rate across all age groups without differences in procedural SAEs.

scholarly journals Outcomes of left atrial appendage occlusion vs. non-vitamin K antagonist oral anticoagulants in atrial fibrillation

2022 ◽  
Author(s):  
Wern Yew Ding ◽  
José Miguel Rivera-Caravaca ◽  
Elnara Fazio-Eynullayeva ◽  
Paula Underhill ◽  
Dhiraj Gupta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Atrial Appendage ◽  
Research Network ◽  
Suitable Alternative ◽  
Left Atrial Appendage Occlusion

Abstract Background The effects of left atrial appendage (LAA) occlusion compared to non-vitamin K antagonist oral anticoagulant (NOAC) therapy in patients with atrial fibrillation (AF) remain unknown. Aims We aimed to evaluate the outcomes in patients with AF who received LAA occlusion vs. NOAC therapy. Methods We utilised data from TriNetX which is a global federated health research network currently containing data for 88.5 million patients. ICD-10 codes were employed to identify AF patients treated with either LAA occlusion or NOAC between 1st December 2010 and 17th January 2019. Clinical outcomes of interest were analysed up to 2 years. Results 108,697 patients were included. Patients who underwent LAA occlusion were younger, more likely to be white Caucasian and male, had a greater incidence of comorbidities, and were less likely to be prescribed other cardiovascular medications. Using propensity score matching, the risk of all-cause mortality was significantly lower among patients who received LAA occlusion compared to NOAC therapy [1.51% vs. 5.60%, RR 0.27 (95% CI 0.14–0.54)], but there were no statistical differences in the composite thrombotic or thromboembolic events [8.17% vs. 7.72%, RR 1.06 (95% CI 0.73–1.53)], ischaemic stroke or TIA [4.69% vs. 5.45%, RR 0.86 (95% CI 0.54–1.38)], venous thromboembolism [1.66% vs. 1.51%, RR 1.10 (95% CI 0.47–2.57)] and intracranial haemorrhage [1.51% vs. 1.51%, RR 1.00 (95% CI 0.42–2.39)]. Conclusion Overall, LAA occlusion might be a suitable alternative to NOAC therapy for stroke prevention in patients with AF. Graphical abstract

scholarly journals Device-Related Thrombus After Left Atrial Appendage Closure

2019 ◽  
Vol 14 (1) ◽  
pp. 42-44 ◽  
Author(s):  
Philippe Garot ◽  
Bertrand Cormier ◽  
Jérôme Horvilleur
Keyword(s):  
Left Atrial ◽  
Time Course ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Late Complications ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure ◽  
Increased Risk ◽  
Incidence Risk ◽  
Potential Benefits

Although left atrial appendage closure (LAAC) has proved non-inferior to oral anticoagulants in patients with AF, there has been recent concern about the occurrence of late complications, especially device-related thrombus (DRT), which was associated with increased risk of stroke. In this article, the incidence, risk factors and time course of DRT after LAAC are discussed, as well as the potential benefits of dedicated strategies in the management of DRT, which remain speculative, especially in patients with a contraindication to oral anticoagulants. In these patients, decision-making should be based on a multidisciplinary evaluation of the ischaemic/bleeding balance on an individual basis.

scholarly journals Percutaneous left atrial appendage occlusion in nonvalvular atrial fibrillation patients with coronary heart disease

2020 ◽  
Author(s):  
Juan Zhang ◽  
Xiaomin Jiang ◽  
Dujiang Xie ◽  
Jie Luo ◽  
Ling Zhou
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Atrial Appendage ◽  
Nonvalvular Atrial Fibrillation ◽  
End Point ◽  
Left Atrial Appendage Occlusion

Abstract Purpose To evaluate the 12-month outcomes of the percutaneous left atrial appendage occlusion (LAAO) procedure in nonvalvular atrial fibrillation (NVAF) patients with coronary heart disease (CAD). Materials and Methods 51 NVAF patients were consecutively accepted LAAO between June 2015 and July 2017. Patients were devided in two groups: 15 with CAD and 36 without CAD. All patients were followed up at 1st, 3rd, 6th, and 12th month after discharge with transesophageal echocardiography (TEE) examination repeated at the same time. Results Among these 51 patients (average age 64.4±10.0, 33.3% female), the procedural success rate was 98% (50/51). During 12-month follow-up, there were no hemorrhagic stroke or major bleeding. The risk of thromboembolism based on CHA2DS2-VASc score (3.1±1.6 vs. 5.2±1.1, P<0.001) and the risk of hemorrhage based on HAS-BLED score (2.2±1.2 vs. 3.1±1.0, P=0.009) in CAD group were significantly higher. The incidence of end-point events had no statistical difference between CAD and non-CAD. Compared with CAD patients who accepted long-term antithrombotic medication, there was no obvious difference in stroke rate and mortality in CAD accepted LAAO group, whereas a further reduction of hemorrhage (n=5/20% vs. n=0, P=0.039) was shown. A significant correlation (P<0.001, r=0.580) was detected between moderate or severe left atrial spontaneous echo contrast (LASEC) and the composite end point events. Conclusion There are similar safety and effectiveness for LAAO procedure in NVAF patients with CAD and without CAD under new oral anticoagulants applied post-implantation anticoagulation strategy. Meanwhile, LASEC is a predictive factor of LAAO in NVAF patients combined CAD.

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.

scholarly journals Percutaneous Left Atrial Appendage Occlusion: A View From the UK

2020 ◽  
Vol 9 (2) ◽  
pp. 83-87
Author(s):  
Wern Yew Ding ◽  
Dhiraj Gupta ◽  
◽  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Anticoagulation Therapy ◽  
Population Data ◽  
Atrial Appendage ◽  
Oral Anticoagulation Therapy ◽  
The Past ◽  
Left Atrial Appendage Occlusion ◽  
Increased Risk ◽  
The Uk

AF is associated with an increased risk of thromboembolic events, which is usually managed with oral anticoagulation therapy. However, despite a broad range of anticoagulant options and improved uptake in anticoagulation over the past decade, there are some limitations to this approach. Percutaneous left atrial appendage occlusion has been shown to be an effective alternative in this setting, and population data suggest a clear demand for this procedure. Over the past decade, several important changes to the commissioning and delivery of this service have occurred in the UK. In this article, the authors describe the use of percutaneous left atrial appendage occlusion in the UK and discuss the challenges that lie ahead.

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