Impact of Left Atrial Appendage Closure on LAA Thrombus Formation and Thromboembolism After LAA Isolation
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Impact of Left Atrial Appendage Closure on LAA Thrombus Formation and Thromboembolism After LAA Isolation. / Fink, Thomas; Vogler, Julia; Heeger, Christian-Hendrik; Sano, Makoto; Sciacca, Vanessa; Reissmann, Bruno; Wohlmuth, Peter; Keelani, Ahmad; Schütte, Christopher; Eitel, Charlotte; Eitel, Ingo; Maurer, Tilman; Rottner, Laura; Rillig, Andreas; Mathew, Shibu; Metzner, Andreas; Ouyang, Feifan; Kuck, Karl-Heinz; Tilz, Roland Richard.
in: JACC-CLIN ELECTROPHY, Jahrgang 6, Nr. 13, 14.12.2020, S. 1687-1697.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Impact of Left Atrial Appendage Closure on LAA Thrombus Formation and Thromboembolism After LAA Isolation
AU - Fink, Thomas
AU - Vogler, Julia
AU - Heeger, Christian-Hendrik
AU - Sano, Makoto
AU - Sciacca, Vanessa
AU - Reissmann, Bruno
AU - Wohlmuth, Peter
AU - Keelani, Ahmad
AU - Schütte, Christopher
AU - Eitel, Charlotte
AU - Eitel, Ingo
AU - Maurer, Tilman
AU - Rottner, Laura
AU - Rillig, Andreas
AU - Mathew, Shibu
AU - Metzner, Andreas
AU - Ouyang, Feifan
AU - Kuck, Karl-Heinz
AU - Tilz, Roland Richard
N1 - Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2020/12/14
Y1 - 2020/12/14
N2 - OBJECTIVES: This study sought to evaluate the safety and effectiveness of electrical isolation of the left atrial appendage (LAAEI) as well as the status of left atrial appendage closure (LAAC) in these patients.BACKGROUND: Catheter-based LAAEI is increasingly performed for treatment of symptomatic atrial fibrillation and pulmonary vein isolation nonresponders. Previous studies indicate an increased incidence of thromboembolic events after LAAEI despite effective oral anticoagulation. Interventional LAAC may prevent cardioembolic events after LAAEI but data regarding safety, feasibility, and efficacy of LAAC in this clinical setting are scarce.METHODS: Consecutive patients who underwent LAAEI at 2 German tertiary care hospitals were analyzed.RESULTS: A total of 270 patients underwent LAAEI by radiofrequency ablation in 255 (94.4%), cryoballoon ablation in 12 (4.4%), and by a combination of both techniques in 3 cases (1.1%). Stroke or transient ischemic attack occurred in 24 of 244 (9.8%) individuals with available follow-up. LAA thrombus formation was found in 53 patients (19.6%). A total of 150 patients underwent LAAC after LAAEI. No LAA thrombus was documented in any patient who underwent LAAC. Of the patients who underwent LAAEI, 67.6% were in sinus rhythm after a mean of 682.7 ± 61.7 days. LAA flow after LAAEI but not arrhythmia recurrence was identified as an independent predictor of stroke and/or transient ischemic attack or LAA thrombus (p < 0.0001).CONCLUSIONS: Sinus rhythm was documented in about two-third of patients undergoing LAAEI as treatment of therapy refractory atrial arrhythmias. LAAC potentially prevents LAA thrombus formation and thromboembolism.
AB - OBJECTIVES: This study sought to evaluate the safety and effectiveness of electrical isolation of the left atrial appendage (LAAEI) as well as the status of left atrial appendage closure (LAAC) in these patients.BACKGROUND: Catheter-based LAAEI is increasingly performed for treatment of symptomatic atrial fibrillation and pulmonary vein isolation nonresponders. Previous studies indicate an increased incidence of thromboembolic events after LAAEI despite effective oral anticoagulation. Interventional LAAC may prevent cardioembolic events after LAAEI but data regarding safety, feasibility, and efficacy of LAAC in this clinical setting are scarce.METHODS: Consecutive patients who underwent LAAEI at 2 German tertiary care hospitals were analyzed.RESULTS: A total of 270 patients underwent LAAEI by radiofrequency ablation in 255 (94.4%), cryoballoon ablation in 12 (4.4%), and by a combination of both techniques in 3 cases (1.1%). Stroke or transient ischemic attack occurred in 24 of 244 (9.8%) individuals with available follow-up. LAA thrombus formation was found in 53 patients (19.6%). A total of 150 patients underwent LAAC after LAAEI. No LAA thrombus was documented in any patient who underwent LAAC. Of the patients who underwent LAAEI, 67.6% were in sinus rhythm after a mean of 682.7 ± 61.7 days. LAA flow after LAAEI but not arrhythmia recurrence was identified as an independent predictor of stroke and/or transient ischemic attack or LAA thrombus (p < 0.0001).CONCLUSIONS: Sinus rhythm was documented in about two-third of patients undergoing LAAEI as treatment of therapy refractory atrial arrhythmias. LAAC potentially prevents LAA thrombus formation and thromboembolism.
KW - Atrial Appendage/diagnostic imaging
KW - Atrial Fibrillation/epidemiology
KW - Catheter Ablation/adverse effects
KW - Humans
KW - Thromboembolism/epidemiology
KW - Thrombosis/epidemiology
U2 - 10.1016/j.jacep.2020.07.003
DO - 10.1016/j.jacep.2020.07.003
M3 - SCORING: Journal article
C2 - 33334448
VL - 6
SP - 1687
EP - 1697
JO - JACC-CLIN ELECTROPHY
JF - JACC-CLIN ELECTROPHY
SN - 2405-500X
IS - 13
ER -