Left Appendage Research Articles

NASCI case of the month: "Unroofed coronary sinus without persistent left-sided superior vena cava".

Unroofed sinus is categorized into four subtypes. Types I and II represent complete unroofing with or without an LSVC, respectively [1]. Types III and IV are partial unroofing involving the mid-CS (type III) or near the LA appendage and left superior pulmonary vein (type IV) [1]. CT has advantages over echocardiography in detection of this anomaly (illustrated in this case) as well as in precise delineation of defect and associated findings (presence or absence of LSVC). Short axis reconstructions at the level of CS are helpful in diagnosis. Considerations for repair include location of CS defect, presence of LSVC and other abnormalities as well as comorbidity risks [2].

B-43 | Outcomes of Left Atrial Appendage Closure With Watchman Among Patients in CKD and ESRD

B-43 | Outcomes of Left Atrial Appendage Closure With Watchman Among Patients in CKD and ESRD

B-38 | Propensity Matched In-Hospital Outcomes of Left Atrial Appendage Occlusion Devices in Younger vs Older Patients

B-38 | Propensity Matched In-Hospital Outcomes of Left Atrial Appendage Occlusion Devices in Younger vs Older Patients

Impact of Left Atrial Appendage Flow Velocity on Thrombus Resolution and Clinical Outcomes in Patients with Atrial Fibrillation and Silent Left Atrial Thrombi: Insights from the LAT Study.

Blood stasis is crucial in developing left atrial (LA) thrombi. LA appendage peak flow velocity (LAAFV) is a quantitative parameter for estimating thromboembolic risk. However, its impact on LA thrombus resolution and clinical outcomes remains unclear. The LAT study was a multicenter observational study investigating patients with atrial fibrillation (AF) and silent LA thrombi detected by transesophageal echocardiography (TEE). Among 17,436 TEE procedures for patients with AF, 297 patients (1.7%) had silent LA thrombi. Excluding patients without follow-up examinations, we enrolled 169 whose baseline LAAFV was available. Oral anticoagulation use increased from 85.7% at baseline to 97.0% at the final follow-up (p < 0.001). During 1-year, LA thrombus resolution was confirmed in 130 (76.9%) patients within 76 (34-138) days. Conversely, 26 had residual LA thrombi, 8 had thromboembolisms, and 5 required surgical removal. These patients with failed thrombus resolution had lower baseline LAAFV than those with successful resolution (18.0 [15.8-22.0] vs. 22.2 [17.0-35.0], p = 0.003). Despite limited predictive power (area under the curve, 0.659; p = 0.001), LAAFV ≤20.0 cm/s (best cutoff) significantly predicted failed LA thrombus resolution, even after adjusting for potential confounders (odds ratio, 2.72; 95% confidence interval, 1.22-6.09; p = 0.015). The incidence of adverse outcomes including ischemic stroke/systemic embolism, major bleeding, or all-cause death was significantly higher in patients with reduced LAAFV than in those with preserved LAAFV (28.4% vs. 11.6%, log-rank p = 0.005). Failed LA thrombus resolution was not rare in patients with AF and silent LA thrombi. Reduced LAAFV was associated with failed LA thrombus resolution and adverse clinical outcomes.

B-36 | In-Hospital Outcomes of Percutaneous Left Atrial Appendage Closure in Patients With Hypertrophic Cardiomyopathy: An Insight From National Inpatient Sample Data

B-36 | In-Hospital Outcomes of Percutaneous Left Atrial Appendage Closure in Patients With Hypertrophic Cardiomyopathy: An Insight From National Inpatient Sample Data

B-35 | Outcomes of Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in Patients With Non-Valvular Atrial Fibrillation: A Meta-Analysis

B-35 | Outcomes of Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in Patients With Non-Valvular Atrial Fibrillation: A Meta-Analysis

C-49 | Concomitant Left Atrial Appendage Exclusion during Cardiac Surgery for patients without a diagnosis of Atrial Fibrillation: A NATIONWIDE ANALYSIS

C-49 | Concomitant Left Atrial Appendage Exclusion during Cardiac Surgery for patients without a diagnosis of Atrial Fibrillation: A NATIONWIDE ANALYSIS

B-39 | Cerebrovascular accidents and mortality following left atrial appendage occlusion in patients with moderate and severe chronic renal impairment: a comprehensive meta-analysis

B-39 | Cerebrovascular accidents and mortality following left atrial appendage occlusion in patients with moderate and severe chronic renal impairment: a comprehensive meta-analysis

B-40 | Safety and Efficacy of Combining Left Atrial Appendage Occlusion With Another Cardiac Procedure

B-40 | Safety and Efficacy of Combining Left Atrial Appendage Occlusion With Another Cardiac Procedure

E-4 | Outcomes of Transcatheter Aortic Valve Replacement With Concomitant Left Atrial Appendage Occlusion Versus Isolated Transcatheter Aortic Valve Replacement: A Meta-Analysis

E-4 | Outcomes of Transcatheter Aortic Valve Replacement With Concomitant Left Atrial Appendage Occlusion Versus Isolated Transcatheter Aortic Valve Replacement: A Meta-Analysis

B-44 | Outcomes of Left Atrial Appendage Closure With Watchman Device in Cirrhosis

B-44 | Outcomes of Left Atrial Appendage Closure With Watchman Device in Cirrhosis

Pre-Clinical Evaluation of Left Atrial Appendage Closure Device in Mitigating Risk of Stroke in Patients with Atrial Fibrillation: Promising Results from Animal Trials with Future Prospects

Abstract: Atrial fibrillation (AF) is the most common clinical disorder of cardiac arrhythmia in geriatrics, characterized by the presence of disorganized and irregular electrical activity in atrial myocardium, which leads to worsening of the heart's systolic function. Left atrial appendage (LAA) is a tubular, tiny aperture construction, connecting the left atrium (LA) with separate structure from LA with distinctive mechanical, hormonal, and structural properties. AF and Mitral valve regurgitation disease elevate the chances of thrombus formation in LAA, these ultimately turns into stroke. Obstructing thrombus by using a Left Atrial Appendage Closure Device (LAAC) and preventing it from entering internal carotid arteries, the risk of LAA thrombosis can be decreased. This article serves as a comprehensive compilation detailing the successful development and implantation of Left Atrial Appendage Closure (LAAC) Device with its novel design and geometry in two pigs (pre-clinical evaluation), showcasing promising results that have future implications for addressing cardiovascular disease in humans.

Prevalence of left atrial appendage thrombus and spontaneous echo contrast on transesophageal echocardiography in patients scheduled for pulmonary vein isolation.

To avoid causing a thromboembolic event in patients undergoing catheter ablation for atrial fibrillation (AF), patients are treated with oral anticoagulants (OAC) prior to the procedure. Despite being on anticoagulants, some patients develop a left atrial appendage thrombus (LAAT). To exclude the presence of LAAT, transesophageal ultrasound (TEE) is performed in all patients prior to the procedure. We hypothesized continuous treatment with anticoagulants would result in a low prevalence of LAAT, in patients with low CHA2DS2-VASc score. Medical records of consecutive patients planned to undergo AF ablation at Lund University Hospital during the years 2018-2020 were reviewed retrospectively. Examination protocols from transesophageal and transthoracic echocardiography were examined for LAAT and spontaneous echo contrast (SEC). Patients with LAAT and SEC were compared to patients without using Mann-Whitney U-test and Pearson Chi-squared analysis to test for correlation. Of 553 patients, three patients (0.54%) had LAAT, and 18 (3.25%) had spontaneous contrast (SEC). Patients with LAAT or SEC had a higher CHA2DS2-VASc score, more often presented in AF at TEE and less often had a normal sized left atrium. There is a low prevalence of LAAT and SEC in patients with AF scheduled for pulmonary vein isolation. Patients with SEC or LAAT tend to have paroxysmal AF less often and more often presented in AF at admission. No patients with CHA2DS2-VASc 0, paroxysmal AF, normal sized left atrium and sinus rhythm at TEE were found to have LAAT or SEC.

The Correlation between Ultrasonographic Morphology and Structure of the Left Atrial Appendage, Blood Flow Velocity, and Plasma Galectin-3 Levels with Thrombus Formation in the Left Atrial Appendage of Patients with Atrial Fibrillation

Background: To explore the correlation between left atrial appendage morphology, blood flow velocity and plasma galectin-3 and thrombosis in patients with atrial fibrillation. Methods: Patients with atrial fibrillation who received treatment and completed ultrasound examination in hospital from 2022 to December 2023 were enrolled. According to whether there was left atrial appendage thrombosis, the patients were divided into a control group (no left atrial appendage thrombosis was found) and a study group (left atrial appendage thrombosis was found). The morphology and structure of the left atrial appendage, blood flow velocity and plasma galectin-3 level were recorded，exploring its correlation with left atrium thrombosis. Results: A total of 330 patients with atrial fibrillation were enrolled, including 278 in the control group and 52 in the study group. Left group and the control group of morphological structure differences (P &lt; 0.05). The main lobe length, ostial area, longest diameter, shortest diameter, left atrial appendage volume and left atrial volume in the study group were higher than those in the control group (P &lt; 0.05). The left atrial appendage emptying velocity, filling velocity and left ventricular ejection fraction of the study group were lower than those of the control group, and the left ventricular end-diastolic diameter was higher than that of the control group (P &lt; 0.05). Group of white blood cell count, neutrophils/lymphocyte ratio, plasma galactose lectin - 3 levels were higher than control group (P &lt; 0.05). ROC curve analysis of left atrial appendage emptying velocity, left atrial appendage filling velocity, left atrial end-diastolic diameter and left atrial ejection fraction had higher diagnostic value (P &lt; 0.05). Conclusion: Left atrial appendage morphology, blood flow velocity and plasma galectin-3 level are important factors to evaluate the risk of left atrial appendage thrombosis in patients with atrial fibrillation, which can be used for clinical diagnosis and decision-making.

Comparison of the efficacy and safety of warfarin anticoagulation and left atrial appendage transcatheter occlusion in the treatment of non-valvular atrial fibrillation and investigation of ET-1, hs-CRP and PDGFs.

This study compared the therapeutic effect and safety between warfarin anticoagulation and percutaneous left atrial appendage transcatheter occlusion (PLAATO) in non-valvular atrial fibrillation (NVAF). A total of 110 patients were selected and assigned to Control group (n=55) and Observation group (n=55). The control patients were used warfarin, while the observation patients were performed PLAATO. The coagulation function, stroke and bleeding scores were compared between the two groups at different times. Left ventricular function before therapy and 1 year after therapy and adverse events during follow-up were compared between the two groups. After one month of treatment, CHA2DS2-VASC, HAS-BLED score, serum ET-1 and hs-CRP levels were lower in the PLAATO patients than in warfarin patients, but serum PDGFs levels were higher than patients in the warfarin patients (P < 0.05). One month after treatment, the activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT) of the PLAATO patients was longer than that of the warfarin patients (P < 0.05), but the levels of fibrinogen (FIB) in the PLAATO patients were lower than that of the warfarin patients (P < 0.05). In addition, one year after therapy, the left atrial end-diastolic volume (LAEDV), left atrial end-systolic volume (LAESV) and left atrial inner diameter of the two groups were significantly reduced (P < 0.05). Left atrial appendage (LAA) occlusion can effectively improve the cardiac function and coagulation function of NVAF patients, with lower incidence of bleeding events, stroke events and higher safety.

Incidence, progression, and predictors of left atrial appendage sealing after Watchman FLX device implantation with computed tomographic assessment.

Limited data exists regarding incidence, progression, and predictors of left atrial appendage (LAA) sealing after transcatheter LAA closure. We aimed to evaluate the incidence, progression, and predictive factors associated with LAA sealing after LAA closure. This study includes patients who underwent successful LAA closure with Watchman FLX device and had both pre- and postprocedural computed tomography (CT). Postprocedural CT was performed 45 days after LAA closure and used to evaluate residual LAA patency. Patient who had residual LAA patency at 45 days underwent 1-year follow-up CT. A total of 105 patients (mean age: 75.2 ± 9.6 years; 53.3% female) who underwent successful LAA closure with Watchman FLX device and had pre- and postprocedural CT at 45 days were included. Residual patency was observed in 35 (33.3%) patients: 21 (20.0%) patients showed complete contrast opacification in LAA (complete LAA patency) while 14 (13.3%) patients showed contrast opacification only in the distal LAA (distal LAA patency). Among patients with residual LAA patency at 45 days, the rate of LAA sealing at 1 year was significantly higher in the distal LAA patency group than in the complete LAA patency group (75.0% vs. 16.7%; p = 0.019). Increased depth oversizing was associated with both distal LAA patency and complete LAA patency. Postprocedural CT at 45 days detected patent LAA in one-third of patients after LAA closure. LAA sealing was more frequently observed at 1 year among the distal LAA patency group than the complete LAA patency group.

Percutaneous closure of incomplete surgical left atrial appendage ligation: success begins with the decision to try.

The authors present a case of percutaneous closure of an incomplete surgical left atrial appendage (LAA) ligation with a new device LAmbre (Lifetech ScientificCo Ltd).

Ischemic stroke associated with high‐grade pedunculated device‐related thrombosis following left atrial appendage closure

Ischemic stroke associated with high‐grade pedunculated device‐related thrombosis following left atrial appendage closure

Safety and efficacy of the second-generation cryoballoon for left atrial appendage electrical isolation in canines.

Left atrial appendage electrical isolation (LAAEI) has demonstrated a significant enhancement in the success rate of atrial fibrillation (AF) ablation. Nevertheless, concerns persist about the safety of LAAEI, particularly regarding alterations in left atrial appendage (LAA) flow velocity and the potential risks of thrombus. This study aimed to assess the efficacy and safety of LAAEI, investigating changes in LAA flow velocity in canines. The study comprised a total of 10 canines. The LAAEI procedure used by a 23 mm cryoballoon of the second generation was conducted at least 180 s. Intracardiac ultrasonography (ICE) was employed to quantify the velocity flow of the LAA both prior to and following LAAEI. Following a 3-month period, subsequent evaluations were performed to assess the LAA velocity flow and the potential reconnection. Histopathological examination was conducted. Left atrial appendage electrical isolation was effectively accomplished in all canines, resulting in a 100% acute success rate (10/10). The flow velocity in the LAA showed a notable reduction during LAAEI as compared with the values before the ablation procedure (53.12 ± 5.89 vs. 42.01 ± 9.22 cm/s, P = 0.007). After the follow-up, reconnection was observed in four canines, leading to a success rate of LAAEI of 60% (6/10). The flow velocity in the LAA was consistently lower (53.12 ± 5.89 vs. 44.33 ± 10.49 cm/s, P = 0.006), and no blood clot development was observed. The histopathological study indicated that there was consistent and complete injury to the LAA, affecting all layers of its wall. The injured tissue was subsequently replaced by fibrous tissue. The feasibility of using cryoballoon ablation for LAAEI was confirmed in canines, leading to a significant reduction of LAA flow velocity after ablation. Some restoration of LAA flow velocity after ablation may be linked to the passive movement of the LAA and potential reconnecting. However, this conclusion is limited to animal study; more clinical data are needed to further illustrate the safety and accessibility of LAAEI in humans.

Prognostic Impact of Left Atrial Appendage Patency After Device Closure

Prognostic Impact of Left Atrial Appendage Patency After Device Closure