China
Africa
Explore chapters and articles related to this topic
3D Printing
Published in Takahiro Shiota, 3D Echocardiography, 2020
Percutaneous approaches to left atrial appendage occlusion have been shown to be effective in patients with thromboembolic risk. Optimal sizing of the left atrial appendage occlusion device is a crucial factor for implantation success. Procedural planning and device sizing are typically guided by echocardiography and fluoroscopy. Fan et al. evaluated the utility of 3D echocardiography datasets to assist in evaluating the left atrial appendage anatomy and testing the occluder device, enabling more accurate sizing, particularly in complex anatomy (Figure 21.8).22 They included 107 consecutive patients undergoing left atrial appendage occlusion using the WATCHMAN device (Boston Scientific, Marlborough, Massachusetts). They compared two groups: imaging-guided group and 3D models–guided group. The imaging alone guided group (72) was based on 3D TEE and fluoroscopy. The 3D printing cohort (32 patients) device selection was prospectively guided by 3D models in adjunct to conventional clinical images (3D transesophageal and fluoroscopy). Compared with the conventional imaging alone cohort, the 3D model-guided patients achieved higher implantation success and shorter procedural times (p < .05) without complications. They had a 100% implantation success in the 3D model–guided group, with an average of 1.1 devices used per procedure.
Transcatheter left atrial appendage occlusion
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Roberto Spina, David W. M. Muller, Brendan Gunalingam
Surgical, pathological, and transoesophageal studies have determined that in non-valvular AF, around 90% of cardiac thrombi arise from the left atrial appendage.12,13 Occlusion of left atrial appendage closure has therefore emerged as a therapeutic modality to reduce the risk of systemic thromboembolism in atrial fibrillation. Historically, left atrial appendage occlusion (LAAO) was performed surgically, often during concomitant coronary artery bypass grafting or valvular or other open-heart interventions. In the last decade, percutaneous transcatheter techniques have become available to exclude the atrial appendage. Several devices have been tested and used in humans, but the two devices most commonly used worldwide currently are the Watchman device (Boston Scientific, Natick, MA, USA) and the Amplatzer Plug (St. Jude Medical, St Paul, MN, USA).
Transseptal catheterization
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Although transseptal puncture at the center of the fossa is usually ideal, some interventions require high or low puncture. The adjunctive use of ICE or TEE has allowed customization of the location of puncture with relative accuracy (Figure 23.15). High fossa puncture is desirable when a relatively perpendicular plane of access is required toward the mitral valve, such as for percutaneous mitral valve repair with a clip device,[71] where a high and posterior approach is helpful for primary or degenerative mitral regurgitation. For left atrial appendage occlusion,[72] low and posterior puncture is generally best. Low puncture is desirable when a relatively shallow entry to the mitral valve is ideal; such was the case for percutaneous metallic mitral commissurotomy.[73]
Atrial fibrillation and stroke
Published in Expert Review of Cardiovascular Therapy, 2023
Sylvia E. Choi, Dimitrios Sagris, Andrew Hill, Gregory Y.H. Lip, Azmil H. Abdul-Rahim
Notwithstanding OAC therapy, there remains a residual risk of treatment failure. Observational data suggests that patients with AF who suffer a stroke while on treatment with OAC are at high risk of recurrent ischemic stroke. Furthermore, changing the type of OAC by switching between VKA and NOAC or from one NOAC to another was not associated with a decreased risk of recurrent ischemic events. Thus, the optimal approach to secondary prevention to reduce the risk of further recurrent events in this high-risk group of patients remains uncertain [233–235]. Although there may be a benefit from alternative strategies, such as left atrial appendage occlusion, there is currently limited evidence on the benefits. However, The Left Atrial Appendage Occlusion Versus Novel Oral Anticoagulation for Stroke Prevention in Atrial Fibrillation Multicenter Randomised Clinical Trial (Occlusion-AF), currently recruiting, will compare left atrial appendage occlusion to NOAC treatment for secondary stroke prevention in patients with AF and a recent stroke or TIA at high risk of recurrent thromboembolic events [236].
Pericardial Anatomy, Interventions and Therapeutics: A Contemporary Review
Published in Structural Heart, 2021
Reza Reyaldeen, Nicholas Chan, Saberio Lo Presti, Agostina Fava, Chris Anthony, E. Rene Rodriguez, Carmela D. Tan, Walid Saliba, Paul C Cremer, Allan L. Klein
Left atrial appendage occlusion has also become an integral part of atrial fibrillation (AF) management, in appropriate patients ineligible for long-term oral anticoagulation. LARIAT atrial appendage ligation is one such strategy that involves pericardial access with endocardial and epicardial magnet-tipped wires and resultant snaring.29 Although less commonly performed compared to endocardial transcatheter occlusion procedures, LARIAT also offers mechanical isolation of the LAA, which can be useful in patients with persistent AF. A 2016 multicenter study including 712 patients undergoing the LARIAT procedure noted over 95% procedural success with <2% risk of complications related to pericardial access,29 demonstrating significant improvement and familiarity in pericardial access, compared to earlier experiences, which reported a complication rate closer to 10%.30 Successful epicardial access relies upon a robust understanding of the pericardial space and attendant anatomical challenges along with procedural awareness for complications.
Biatrial ablation vs. Pulmonary vein isolation in atrial fibrillation patients undergoing cardiac surgery: a retrospective study
Published in Scandinavian Cardiovascular Journal, 2021
Mine Onat Hald, Daniel Julius Lauritzen, Johan Heiberg, Winnie Juhl, Emmanuel Moss, Henrik J. Vodstrup
According to the guidelines from the European Society of Cardiology [2], surgical ablation and left atrial appendage occlusion should be considered in most patients with AF undergoing cardiac surgery. A biatrial ablation procedure is very effective and up to 90% freedom from AF has been reported [1,3]. The less complex alternative is to perform a pulmonary vein isolation (PVI), which makes the procedure more easily applicable for a wider spectrum of cardiac surgeons. Accordingly, a European Heart Rhythm Association consensus statement recommend that a biatrial procedure should be considered for those with persistent or long-standing persistent AF [4]. In clinical practice, surgeons may opt for a more complete biatrial ablation during mitral valve procedures since the left atrium is opened but may perform only PVI when a mitral valve procedure is not indicated, regardless of the type of AF. In a randomized trial, Gillinov et al. [5] observed that the biatrial procedure resulted in more patients in need of a permanent pacemaker post ablation. This raises the question of which ablation, PVI or a biatrial procedure, to choose for a given type of AF, balancing the freedom from AF against the risk of requiring a permanent pacemaker. In this retrospective single center study, we aimed to compare the prevalence of freedom from AF and permanent pacemaker implantation in patients undergoing either a biatrial or PVI procedure. Moreover, we sought to determine which patient- and procedure-related factors predict freedom from AF after concomitant surgical ablation.