Left Appendage Research Articles

Efficacy and safety of intracardiac echocardiography-guided "one-stop" procedures combining radiofrequency catheter ablation and left atrial appendage closure in elderly patients with atrial fibrillation

Objective: To assess the efficacy and safety of "one-stop" procedures combining radiofrequency catheter ablation and left atrial appendage closure by guidance of intracardiac echocardiography(ICE) in elderly patients with atrial fibrillation. Methods: A retrospective cohort study was conducted on patients who underwent ICE-guided "one-stop" procedures at the Department of Cardiology, General Hospital of Northern Theater Command between December 2020 and January 2023. Patients were divided into elderly group (age≥60 years old) and non-elderly group (age 18-59 years old). The clinical characteristics, acute success rate, peri-operative complications and follow-up data between two groups were compared. Multivariate logistic regression analysis was used to analyze whether age was the influencing factor for perioperative complications and atrial fibrillation recurrence. Results: A total of 213 atrial fibrillation patients were enrolled, including 158 (74.18%) in the elderly group (age: (68.3±5.0) years; 56.96% male) and 55 (25.82%) in the non-elderly group (age: (53.7±5.2) years; 81.82% male). The elderly group had lower proportions of males, persistent atrial fibrillation, and left atrial spontaneous echocardiographic contrast compared to the non-elderly group (P<0.05). CHA2DS2-VASc and HAS-BLED scores were higher in elderly group (P<0.05). The acute success rate,"one-stop" procedure time, fluoroscopy time and the rate of peri-operative complications (6 (3.80%) in elderly group vs. 2 (3.64%) in non-elderly group) were similar between two groups (all P>0.05). The average time of clinical and telephone interviews in elderly group and non-elderly group was (16.9±6.1) months and (17.9±5.9) months, respectively. There was no significant difference in the rate of atrial fibrillation recurrence or clinical events between two groups (47 (30.72%) vs. 14 (26.42%), P=0.554; 10 (6.54%) vs. 2(3.77%), P=0.689, respectively). Iatrogenic atrial septal defects in 3-month transesophageal echocardiography follow up were detected in 44 patients (36.97%) in elderly group and 9 patients (19.57%) in non-elderly group (P=0.032). Multivariate logistic regression analysis results showed that age was not the influencing factor for peri-operative complications and atrial fibrillation recurrence (P=0.905 and P=0.676, respectively). Conclusion: Intracardiac echocardiography-guided "one-stop" procedures in the treatment of atrial fibrillation in elderly patients are safe and effective.

The role of multi-modality imaging for the assessment of left atrium and left atrial appendage. A clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC).

Structural, architectural, contractile or electrophysiological alterations may occur in the left atrium (LA). The concept of LA cardiopathy is supported by accumulating scientific evidence demonstrating that LA remodeling has become a cornerstone diagnostic and prognostic marker. The structure and the function of LA and left atrial appendage (LAA) which is an integral part of the LA, are key elements for a better understanding of multiple clinical conditions, most notably atrial fibrillation (AF), cardioembolism, heart failure and mitral valve diseases. Rational use of various imaging modalities is key to obtain the relevant clinical information. Accordingly, this clinical consensus document from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists and cardiac imagers for the best practice of imaging LA and LAA for the diagnosis, management and prognostication of the patients.

Left atrial appendage occlusion and radiofrequency ablation in a patient with atrial fibrillation and dextrocardia: a case report

BackgroundDextrocardia is a rare congenital condition, affecting approximately 1 in 10,000–12,000 individuals. When combined with atrial fibrillation (AF), it becomes even rarer. “One-stop” surgery, including combined radiofrequency ablation (RFA) and left atrial appendage occlusion (LAAO), has become a common clinical treatment for patients with AF who develop cerebral infarction despite regular oral anticoagulants. To date, no cases have been reported of patients with AF and dextrocardia undergoing the “one-stop” procedure, making this surgery particularly challenging.Case presentationAn 85-year-old dextrocardia male with total visceral inversion and persistent AF developed cerebral infarction despite regular oral anticoagulation therapy. He was referred to our hospital for RFA of AF and LAAO. The procedure was successfully performed using a three-dimensional electroanatomical mapping system (Carto3, Biosense Webster, Diamond Bar, CA, USA), intracardiac echocardiography (ICE), and x-ray, with no complications.ConclusionThis is the first reported case of a “one-stop” surgery for dextrocardia with AF. This procedure is safe and feasible with the assistance of advanced technologies such as ICE and the VIZIGO bidirectional adjustable bent sheath.

Clinical and Biomarker Determinants for Recurrent Stroke in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Despite effective secondary prevention, including oral anticoagulant (OAC) therapy, the risk of recurrent stroke (RS) in patients with atrial fibrillation (AF) remains substantial with an annualized risk of 3.2%-6.5% per year. The reasons for this high residual risk are unclear. There is growing need for improved risk prediction tools to identify patients at greatest risk of RS in AF and to find new therapeutic targets for secondary prevention. Our objective was to perform a systematic review to investigate the association of clinical factors and echocardiographic, blood, and neuroimaging biomarkers, with stroke recurrence after AF-related stroke. We searched Embase/Ovid Medline until August 2023. Studies were included irrespective of OAC use. Risk ratios (RRs) were pooled using random effects. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Of 5,427 records searched, 42 reports from 28 studies including 52,798 patients (5,046 RS events during follow-up) were identified. In addition to the CHA2DS2-Vasc score (RR 1.22, 95% CI 1.15-1.30, per point) and its individual components, the clinical factors associated with recurrence were a qualifying stroke despite OAC (RR 1.55, 1.23-1.94 [vs OAC-naïve]), sustained AF (RR 1.44, 1.19-1.75 [vs paroxysmal]), hyperlipidemia (RR 1.27, 1.05-1.53), chronic kidney disease (RR 1.86, 1.19-2.92), and malignancy (RR 4.36, 1.85-10.78). NIH Stroke Scale scores (RR 0.97, 0.95-0.99) and Asian ethnicity (RR 0.59, 0.36-0.97) were associated with a reduced risk of recurrence. Known AF was not associated with a higher risk of stroke compared with AF detected after stroke (RR 1.20, 0.93-1.55). Neuroimaging markers associated with RS included chronic lacunar (RR 1.91, 1.29-2.84) or embolic-appearing (RR 2.76, 1.32-5.77) infarcts and cerebral microbleeds (RR 1.29, 1.04-1.59). Echocardiographic markers included atrial size (RR 1.40, 1.12-1.75 per cm/m2), intracardiac thrombus (RR 1.99, 1.38-2.87), spontaneous left atrial appendage (LAA) echocardiographic contrast (RR 2.91, 1.21-6.17), or low LAA intensity variation (RR 2.81, 1.48-5.32). Data were limited for blood biomarkers. We identified several clinical factors associated with recurrence after AF-related stroke, with AF burden and stroke despite OAC of particular clinical relevance. Biomarkers of atrial cardiopathy, small vessel disease, or previous infarction were also associated with RS. Collaborative efforts are needed to identify and validate new risk factors and biomarkers of RS in AF.

Cardiac computer tomography-derived radiomics in assessing myocardial characteristics at the connection between the left atrial appendage and the left atrium in atrial fibrillation patients

ObjectivesTo evaluate the feasibility of utilizing cardiac computer tomography (CT) images for extracting the radiomic features of the myocardium at the junction between the left atrial appendage (LAA) and the left atrium (LA) in patients with atrial fibrillation (AF) and to evaluate its asscociation with the risk of AF.MethodsA retrospective analysis was conducted on 82 cases of AF and 56 cases in the control group who underwent cardiac CT at our hospital from May 2022 to May 2023, with recorded clinical information. The morphological parameters of the LAA were measured. A radiomics model, a clincal feature model and a model combining radiomics and clinical features were constructed. The radiomics model was built by extracting radiomic features of the myocardial tissue using Pyradiomics, and employing Least absolute shrinkage and selection operator (LASSO) method for feature selection, combining random forest with support vector machine (SVM) classifier.ResultsThere were 82 cases in the AF group [44 males, 65.00 (59, 70)], and 56 cases in the control group (21 males, 61.09 ± 7.18). Age, BMI, hypertension, CHA2DS-VASC score, neutrophil to lymphocyte ratio (NLR), LAA volume, LA volume, the myocardial thickness at the junction of LAA and LA, the area, circumference, short diameter, and long diameter of the LAA opening, were significantly different between the AF group and the control group (P &amp;lt; 0.05). After conducting multivariate logistic regression analysis, it was found that BMI, the myocardial thickness at the junction of the LAA and the LA, LA volume, NLR and CHA2DS-VASC score were related to AF. 12 radiomics features of the myocardium at the junction of the LAA and the LA were extracted and identified. ROC curve analysis confirmed that the nomogram based on radiomics scores and clinical factors can effectively predict AF (AUC 0.869).ConclusionRadiomics enables the extraction of the myocardial characteristics at the junction of the LAA and the LA, which are related with AF, facilitating the assessment of its relationship with the risk of AF. The combination of radiomics with clinical characteristics enhances the evaluation capabilities significantly.

Prevalence and predictors of left atrial thrombus in patients with rheumatic atrial fibrillation undergoing cardiac surgery: a cross-sectional study

BackgroundUnlike non-rheumatic atrial fibrillation (AF), where left atrial thrombus (LAT) is predominantly confined to the left atrial appendage (LAA), a significant proportion of LAT in rheumatic AF occurs within the left atrial cavity (LAC). However, LAC thrombosis in rheumatic AF has not been extensively studied. This study aimed to evaluate the prevalence of LAT and its subtypes and identify potential predictors of LAT.MethodsThis retrospective study included adult patients with rheumatic AF who underwent open-heart surgery for mitral valvular abnormalities between January 2019 and December 2020. LAT was identified through intraoperative inspection and categorized as either LAC thrombus or LAA thrombus. The prevalence of LAT and its subtypes was calculated, and logistic regression analysis was performed to identify predictors of LAT.ResultsA total of 530 patients (mean age: 59.7 ± 9.5 years; male: 29.8%) with a predominance of mitral stenosis (59.6%) were included. LAT was identified in 82 patients (15.5%), including 44 (8.3%) with LAA thrombus and 38 (7.2%) with LAC thrombus. In the multivariable logistic regression model, coronary artery disease (OR: 6.35, 95% CI: 2.79–14.46, p < 0.001), larger left atrial diameter (OR: 1.31 per 10 mm increase, 95% CI: 1.02–1.68, p = 0.03), and moderate-to-severe mitral stenosis (OR: 1.77, 95% CI: 1.00–3.13, p = 0.05) were independently associated with an increased risk of LAT, whereas moderate-to-severe mitral regurgitation was independently associated with a decreased risk of LAT (OR: 0.21, 95% CI: 0.11–0.43, p < 0.001).ConclusionIn patients with rheumatic AF undergoing open-heart mitral valve surgery, LAT can be located in either the LAA or LAC. The presence of LAT was independently associated with coronary artery disease, left atrial enlargement, and mitral valvular abnormalities. Timely screening and management of LAT are crucial to mitigate potentially fatal thromboembolic events.

WATCHMAN versus LACbes® device for percutaneous left atrial appendage closure: a single-center, propensity-matched study

BackgroundDifferent left atrial appendage closure (LAAC) devices have been introduced into the clinical setting. A new dual-seal mechanism LACbes® occluder with isogenous barbs for LAAC has been designed to facilitate easier delivery and improve safety. The purpose of this study is to compare the clinical outcomes of the WATCHMAN with those of the LACbes® device for LAAC.MethodsConsecutive patients with atrial fibrillation (AF) who had undergone LAAC performed using a WATCHMAN or LACbes® device from June 2016 to February 2022 were included. The primary efficacy endpoint included ischemic stroke, cardiovascular/unexplained death and device-related thrombus, while the primary safety endpoint included major peri-procedural complications and major bleeding events during clinical follow-ups. 1:1 propensity score matching (PSM) was performed.ResultsAfter PSM, 184 patients were included in each group. The mean CHA2DS2-VASc score was 3.1 ± 1.5 (LACbes®) vs. 3.1 ± 1.4 (WATCHMAN), and the HAS-BLED score was 2.7 ± 1.1 vs. 2.7 ± 1.0. At a mean follow-up of 2.5 ± 1.5 vs. 2.4 ± 0.9 years, the defined three endpoints were comparable between the two groups. The occurrence of all-cause stroke was lower in 5/452 (1.8%) with LACbes® vs. 16/433 (3.7%) with WATCHMAN occluders (HR, 0.40, 95% confidence interval (CI), 0.18–0.89, P = 0.023), and the incidence of any bleeding was higher in the WATCHMAN group (41/433, 9.5% vs. 8/452, 1.8%; HR, 0.19, 95% CI, 0.11–0.33).ConclusionThe LACbes® occluder exhibited comparable safety and efficacy of stroke prevention for AF when compared with the WATCHMAN device.

Enhanced Endothelialization Using Resveratrol-Loaded Polylactic Acid-Coated Left Atrial Appendage Occluders in a Canine Model.

Left atrial appendage occlusion (LAAO) is a well-established alternative to anticoagulation therapy for patients with atrial fibrillation who have a high bleeding risk. After occluder implantation, anticoagulation therapy is still required for at least 45 days until complete LAAO is achieved by neoendocardial coverage of the device. We applied a polylactic acid-resveratrol coating to the LAAO membrane to enhance endothelialization with the goal of shortening the anticoagulation therapy duration. Eighteen dogs were randomly divided into the experimental group (coated occluders) or the control group (noncoated occluders). The dogs were sacrificed in cohorts at days 14, 28, and 90 for anatomical and pathological examination to evaluate endothelialization and thrombus formation. Transesophageal echocardiography (TEE) was performed before sacrifice to evaluate device-related adverse events. According to the anatomical and pathological examinations, all except one LAAO cover exhibited larger or thicker tissue or neoendocardial coverage in the experimental group compared with the control group at the same sacrifice time points. All connection hubs were densely covered by endothelial cells at 90 days and completely covered at 28 days in the experimental group, while all connection hubs were thinly covered at 90 days and two connection hubs were exposed at 28 days in the control group. Pathological examination revealed no thrombus formation in the experimental group, while a small amount of thrombus was observed in one dog at 90 days and in two dogs at 28 days in the control group. Finally, TEE showed no peri-device leakage (PDL) in the experimental group, whereas a small amount of PDL was detected in one dog (3.2 mm) at 28 days and in one dog (3.7 mm) at 14 days in the control group. The resveratrol-loaded polylactic acid-covered LAAO device enhanced endothelialization and reduced thrombus formation and PDL. This effect could possibly reduce the anticoagulation therapy duration.

Giant left atrial appendage aneurysm: a source of multiple thrombotic events despite medical therapy.

Giant left atrial appendage aneurysm: a source of multiple thrombotic events despite medical therapy.

Effect analysis of radiofrequency catheter ablation in the treatment of 7 children with atrial tachycardia-induced cardiomyopathy

BackgroundTachycardia-induced cardiomyopathy refers to changes in cardiac structure and function that result from rapid arrhythmia and can manifest as a continuous or recurrent event. Cardiomyopathy induced by atrial tachycardia is typically reversible if the arrhythmia is effectively controlled. There are few literature reports of atrial tachycardia-induced cardiomyopathy in children, and fewer cases have been effectively treated by radiofrequency catheter ablation in children.Objectivewe conducted a clinical summary of 7 cases of atrial tachycardia-induced cardiomyopathy in children in Wuhan Children’s Hospital to investigate the effectiveness and safety of radiofrequency catheter ablation for atrial tachycardia-induced cardiomyopathy.MethodsA total of 7 children (4 girls and 3 boys) diagnosed with atrial tachycardia-induced cardiomyopathy and admitted to Wuhan Children’s Hospital from January 2017 to April 2024 were selected. An intracardiac electrophysiological study was conducted on all 7 children to verify the origin of the atrial tachycardia and the presence of decreased cardiac function. All children were followed up for a period ranging from 2 to 12 months after RFCA or atrial appendectomy. During this follow-up, left ventricular end-diastolic diameter and left ventricular ejection fraction were monitored.ResultsThe age range was 3.6 to 13 years and the median age was 11.2 years. The weight range was from 15 to 92 kg, the average weight was 34 kg. The results of the intracardiac electrophysiological study of the 7 cases showed that the origin came from the right pulmonary vein in 2 cases, from the left pulmonary vein in 2 cases, from the left atrial appendage in one case, and from the right atrial appendage in 2 cases. Four cases of tachycardia-induced cardiomyopathy originating in the left and right pulmonary veins were successfully eliminated by radiofrequency catheter ablation (RFCA). The foci of atrial tachycardia were located in the atrial appendages of three children. For two of them, after precise positioning by the atrium three-dimensional electroanatomic mapping system and performing RFCA, the atrial tachycardia briefly stopped for approximately 24 h before reoccurring, and atrial appendectomy was subsequently performed. Nevertheless, in the other child, whose focus of atrial tachycardia was in the right atrial appendage, the lesion was successfully eliminated by RFCA. After RFCA or in combination with atrial appendectomy, 6 children were followed for more than 1 year and 1 child for 2 months. All children had sinus rhythm. At the same time, the left ventricular ejection fraction after RFCA or combined atrial appendectomy was significantly increased in 7 cases, indicating statistical significance (P = 0.018)), but the left ventricular end-diastolic diameter was not statistically significant in the treatment (P = 0.203)).ConclusionsSustained atrial tachycardia can lead to the occurrence of cardiomyopathy such as cardiac enlargement and heart failure. RFCA and combined atrial appendectomy can effectively stop tachycardia, eliminate the mechanism of tachycardia, and allow complete recovery of cardiac function.

Left atrial appendage occlusion: trends in demographics and in-hospital outcomes-a German nationwide analysis.

LAAO is an interventional, prophylactic treatment to prevent cardioembolic stroke in patients with non-valvular atrial fibrillation. The aim of this study was to assess gender differences and age-related in-hospital course of all patients undergoing left atrial appendage occlusion (LAAO) in Germany. The Research Data Center of the Federal Statistical Office accessed interrogation of its Diagnosis Related Groups (DRG) statistics database. In a retrospective observational manner, all German in-hospital cases from 2016 to 2022 with a coded LAAO procedure were analyzed. LAAO was performed on a total of 40,435 patients, 39.2% of whom were female. The relative frequency of procedures in the German male population over the age of 60 was twice as high as in the German female population. The median age was 78 (IQR: 72-82) years. Compared to 28.3% in 2016, in 2022 40.1% of all patients were over 80years of age (increased by 152%). Cases of patients over 85years of age increased from 7.7 to 11.4% during the same time period. We found an in-hospital death rate for patients < 70, 70-75, 80-85 and > 85years of age of 0.8, 1.0, 1.4and 2.2% respectively. Further, we saw significantly higher MACE rates (< 75years: 4%, 75-85years: 5%, > 85years: 7%) in patients with a higher age. Gender was not significantly associated with a higher rate of in-hospital mortality. In Germany, LAAO is increasingly performed in older patients with a strong gender imbalance. Age was independently associated with higher in-hospital MACE and mortality rates. This data provides a further basis to balance risks and benefits of LAAO as a preventive procedure and highlights the need for further prospective studies.

Current Status of CT Imaging Before Common Transcatheter Interventions for Structural Heart Disease.

Background: Over the past decade, several trials and observational studies have validated the use of minimally invasive cardiac interventions as viable treatment options for various cardiac diseases. Transcatheter techniques for severe aortic valve stenosis have rapidly emerged as alternatives to surgical aortic valve replacement in certain patient populations. Additionally, non-surgical treatment options have expanded for conditions affecting other cardiac valves, such as the mitral valve. These emerging minimally invasive interventions complement already well-established endovascular techniques for, among others, atrial septal defect closure, left atrial appendage occlusion and pulmonary vein isolation in patients with atrial fibrillation. Given their non-surgical nature and lack of direct visualisation of the targeted anatomy, these procedures heavily rely on precise pre-procedural radiological imaging for optimal patient selection and procedural success. Method: This paper is based on the expert opinion of the authors and an exhaustive literature research. Results: This manuscript reviews the most commonly employed minimally invasive cardiac interventions, highlighting the essential pre-procedural imaging information and key aspects that must be included in radiological reports to mitigate potential complications. Conclusion: Accurate pre-procedural imaging is crucial for ensuring safe and effective minimally invasive cardiac interventions, underscoring the importance of the radiologist in the pre-procedural work-up of these patients.

Left Atrial Thrombus after Transcatheter Mitral Edge-to-Edge Repair in a Patient with Left Appendage Occlusion.

A 67-year-old man with a history of heart failure (HF) secondary to ischemic cardiomyopathy, atrial fibrillation, and left atrial appendage occlusion (LAAO) developed worsening HF secondary to severe functional mitral regurgitation. Consequently, transcatheter edge-to-edge repair (TEER) was performed. Despite successful TEER, a large thrombus in the left atrium (LA) was unexpectedly discovered on postoperative day 3. Thrombus formation may be related to changes in the blood stream in the LA, endothelial injury by septal puncture, and an insufficient anti-thrombotic regimen. This case highlights the potential for the development of subacute LA thrombosis following TEER, even in patients with prior LAAO.

Prevalence of discussions around left atrial appendage occlusion as a treatment option in patients on oral anticoagulation experiencing a major bleeding event

BackgroundGuidelines recommend considering percutaneous left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF) at moderate to high stroke risk and contraindications to long-term anticoagulation. Discontinuation of anticoagulation in this patient population, without an alternative treatment option, may place patients at unnecessary risk. This study aimed to assess the prevalence of discussions around LAAO as a treatment option following major bleeding adverse events in patients on oral anticoagulation for AF and to identify the proportion of patients stopping anticoagulation without evidence of LAAO discussions. MethodsFrom a single, large medical center in the United States, patients on an oral anticoagulant for AF and having at least one major bleeding adverse event, defined by the International Society on Thrombosis and Haemostasis, between January 2015 and October 2023 were identified within a quality improvement registry. Information about LAAO discussions, subsequent procedures, and permanent discontinuation of anticoagulation was assessed using the Electronic Medical Record Search Engine and manual electronic medical record reviews. ResultsA total of 222 patients experienced major bleeding (54.5 % male, 86.9 % white, median age 77 years, 58.6 % on warfarin). From this group, 283 major bleeds were documented (44.2 % gastrointestinal, 17.7 % intracranial). LAAO discussions were documented in 51 patients (23 %), with LAAO procedures performed in 9 of these patients (17.6 %). After the major bleed, 54 (24.3 %) patients permanently stopped anticoagulation. Of these patients, 18 (33.3 %) had LAAO discussions prior to discontinuation and only 1 (1.9 %) had LAAO implantation. ConclusionsIn patients experiencing a major bleed, less than a quarter had documented discussions about LAAO and over a quarter permanently stopped anticoagulation.

Surface steel ball calibration - A novel method for facilitating fluoroscopic measurement during implantation of WATCHMAN.

Although the method of autocalibration or calibration based on catheter diameters was proposed for fluoroscopic measurement during percutaneous left atrial appendage occlusion (LAAO), it may be imprecise and lead to mismeasurement. We sought to investigate whether the utilization of the surface steel ball calibration (SSBC) method under fluoroscopy could facilitate the fluoroscopic measurement of the post-implanted WATCHMAN device (Boston Scientific Corporation, Natick, MA, USA) in LAAO. This retrospective study included 97 consecutive patients who underwent percutaneous LAAO with the WATCHMAN device. The SSBC method and sheath calibration method under fluoroscopy, and transesophageal echocardiography (TEE) were employed to measure the diameter of the post-implanted device during the LAAO procedure. The results of the three methods were then compared. The success rate for procedural WATCHMAN implantation was 100 %. The mean maximal diameter of the post-implanted devices was 24.7 ± 3.1 mm, 23.5 ± 3.2 mm, and 24.2 ± 3.0 mm, as measured by the SSBC method, sheath calibration method, and TEE, respectively (all p < 0.001). The relevant coefficient of correlation between the SSBC method/TEE, SSBC method/sheath calibration method, and TEE/sheath calibration method, was 0.94, 0.93, and 0.89, respectively (all p < 0.001). The SSBC method, when employed under fluoroscopy, demonstrated a high correlation with the sheath calibration method and TEE for measurements. It may be applied to facilitate fluoroscopic measurements during percutaneous LAAO procedures.

Left Atrial Appendage Electrical Isolation in Long-Standing Persistent Atrial Fibrillation: Lupus in Fabula

Left Atrial Appendage Electrical Isolation in Long-Standing Persistent Atrial Fibrillation: Lupus in Fabula

Left atrial appendage occlusion devices: one size doesn't fit all? The turning point of a custom-made device

Left atrial appendage occlusion devices: one size doesn't fit all? The turning point of a custom-made device

Left atrial appendage closure guided by fusion of computational-simulated device on real-time fluoroscopy: A multicenter experience

Left atrial appendage closure guided by fusion of computational-simulated device on real-time fluoroscopy: A multicenter experience

Innovative Strategies for Mini-Invasive Left Atrial Appendage Closure

Innovative Strategies for Mini-Invasive Left Atrial Appendage Closure

Safety and efficacy of a light antithrombotic regimen after left atrial appendage occlusion: Insights from the LOGIC (left atrial appendage occlusion in patients with gastrointestinal or IntraCranial bleeding) international multicenter registry.

Antithrombotic therapy (AT) after left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (NVAF) has the purpose of preventing device related thrombosis (DRT), avoiding embolic events; nevertheless, the correct antithrombotic regimen after LAAO is still under debate. Aim of this substudy of the observational LOGIC registry was to describe the efficacy and safety of a light antithrombotic regimen, comprising single antiplatelet therapy or none, compared to a standard antithrombotic regimen, after a successful LAAO. Patients with NVAF that underwent LAAO were previously included in the LOGIC registry. Patients receiving single or no AT were considered as light therapy group, while other regimen were considered as standard regimen group. Outcomes of interest were death from any causes and cardiovascular death, ischemic stroke, transient ischemic attack and systemic embolization, any bleeding and major bleeding at 12months. Six hundred and twenty-eight patients were considered in the analysis, 31.4% received a light antithrombotic regimen. There were no differences in overall and cardiovascular mortality (5.1% Vs 6.7%, p=0.426 and 2.0% Vs 1.4%, p=0.553 respectively). Cerebrovascular stroke and transient ischemic attack were similar between the two groups (1.5% Vs 1.4%, p=0.898 and 1.5% Vs 1.3%, p=0.847). Light regimen was not associated with an increased rate of systemic embolism (1.0% Vs 0.7%, p=0.447 and HR 0.88 [95% CI: 0.34-2.27; p=0.79]). A light AT regimen did not affect bleeding events being not different between the two groups (HR 0.71; 95% CI: 0.33-1.59; p=0.41). An AT regimen based on single or no antithrombotic therapy after LAAO seems to be safe in patients with high-bleeding risk, without increasing cerebrovascular or peripheral ischemic events.