Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LA...Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.展开更多
BACKGROUND There are very few cases of cardiac occluder detachment,and it is rare to completely remove the occluder using interventional methods without undergoing thoracotomy surgery after detachment.This case innova...BACKGROUND There are very few cases of cardiac occluder detachment,and it is rare to completely remove the occluder using interventional methods without undergoing thoracotomy surgery after detachment.This case innovatively used ultrasound guidance combined with digital subtraction angiography(DSA)to completely remove the occluder,accumulating some experience.CASE SUMMARY The patient underwent left atrial appendage occlusion surgery in our hospital due to atrial fibrillation.After the surgery,the occluder fell off and became free in the left ventricle,which is very dangerous.We innovatively used ultrasound guidance,combined with DSA,and interventional surgery to successfully capture the free occluder using a catcher,completely remove it,and then re implant a new left atrial appendage occluder.After the surgery,the patient recovered very well.CONCLUSION The size selection of the occluder is slightly conservative,and the shape of the left atrial appendage opening is irregular.展开更多
BACKGROUND Inflammatory indices derived from complete blood tests have been reported to be associated with poor outcomes in patients with atrial fibrillation(AF).The data about the relationship between inflammatory in...BACKGROUND Inflammatory indices derived from complete blood tests have been reported to be associated with poor outcomes in patients with atrial fibrillation(AF).The data about the relationship between inflammatory indices and left atrial appendage thrombus(LAAT)or dense spontaneous echo contrast(SEC)are limited.AIM To explore the value of inflammatory indices for predicting the presence of LAAT or dense SEC in nonvalvular AF patients.METHODS A total of 406 patients with nonvalvular AF who underwent transesophageal echocardiography were included and divided into two groups based on the presence(study group)or absence(control group)of LAAT or dense SEC.Inflammatory indices,including the neutrophil-to-lymphocyte ratio(NLR),platelet–tolymphocyte ratio(PLR),and lymphocyte-to-monocyte ratio(LMR),were calculated from complete blood analysis.The associations of inflammatory indices RESULTS LAAT and dense SEC were detected in 11(2.7%)and 42(10.3%)patients,respectively.The PLR only showed an association with LAAT/dense SEC in the univariate model.Elevated NLR(odds ratio[OR]=1.48,95%confidence interval[CI]:1.11-1.98,P=0.007)and reduced LMR(OR=0.59,95%CI:0.41-0.83,P=0.003)were found to be independent risk factors for the presence of LAAT/dense SEC.The areas under the NLR and LMR curves for predicting LAAT/dense SEC were 0.73(95%CI:0.66-0.80,P<0.001)and 0.73(95%CI:0.65-0.81,P<0.001),respectively,while the cutoff values were 2.8(sensitivity:69.8%;specificity:64.0%)and 2.4(sensitivity:71.7%;specificity:60.6%),respectively.CONCLUSION Increased NLR and decreased LMR may predict LAAT/dense SEC in patients with nonvalvular AF.展开更多
AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO)during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all eligi...AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO)during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery.Clinical outcomes during follow-up included:embolic events,stroke,all-cause mortality,atrial fibrillation(AF),reoperation for bleeding and postoperative complications.We further stratified the analysis based on propensity matched studies and AF predominance.RESULTS Twelve studies(n=40107)met the inclusion criteria.s-LAAO was associated with lower risk of embolic events(OR:0.63,95%CI:0.53-0.76;P<0.001)and stroke(OR:0.68,95%CI:0.57-0.82;P<0.0001).Stratified analysis demonstrated this association was more prominent in the AF predominant strata.There was no significant difference in the incidence risk of allcause mortality,AF,and reoperation for bleeding and postoperative complications.CONCLUSION Concomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke,especially in those with AF without significant increase in adverse events.Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.展开更多
Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients...Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients with contraindications to chronic oral anticoagulation. The promise of this new intervention compared with warfarin has been supported by several, small studies and two pivotal randomized trial with the Watchman Device. The results regarding risk reduction for stroke have been favourable although acute complications were not infrequent. Procedural complications, which are mainly related to transseptal puncture and device implantation, include air embolism, pericardial effusions/tamponade and device embolization. Knowledge of nature, management and prevention of complications should minimize the risk of complications and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke.展开更多
Non-valvular atrial fibrillation is associated with a significantly increased risk of embolic stroke due to blood clot forming predominantly in the left atrial appendage(LAA). Preventive measures to avoid embolic even...Non-valvular atrial fibrillation is associated with a significantly increased risk of embolic stroke due to blood clot forming predominantly in the left atrial appendage(LAA). Preventive measures to avoid embolic events are permanent administration of anticoagulants or surgical closure of the LAA. Various clinical trials provide evidence about safety, effectiveness and therapeutic success of LAA occlusion using various cardiac occluder devices. The use of such implants for interventional closure of the LAA is likely to become a valuable alternative for stroke prevention, especially in patients with contraindication for oral anticoagulation as safety, clinical benefit and cost-effectiveness of LAA occlusion has recently been demonstrated.展开更多
Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of st...Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of stroke or systemic embolism.[1]Abnormal hemodynamic changes in elder atrial septal defect(ASD)patients cause remodeling of the left atrium,which eventually leads to right heart failure.[2]As the ASDs elderly are associated with a higher incidence of AF,simultaneous transcatheter ASD and LAA closure has become a new effective therapeutic strategy.However,only a limited number of articles involving cardiac tamponade complications have been published in the literature.What’s more,previous studies involving early hemodynamically irrelevant pericardial effusion after the procedure attribute to multiple repositioning attempts of LAA occluder or delivery sheath injured the atrial wall.展开更多
BACKGROUND In mirror-image dextrocardia,the anterior-posterior position of the cardiac chambers and great vessels is maintained,but the left-right orientation of the abdominal organs is reversed.The abnormal anatomy o...BACKGROUND In mirror-image dextrocardia,the anterior-posterior position of the cardiac chambers and great vessels is maintained,but the left-right orientation of the abdominal organs is reversed.The abnormal anatomy of the heart poses surgical challenges and problems in dealing with surgical risk and monitoring complications.There are few reports on closure of the left atrial appendage(LAA)in dextrocardia and no reports on the application of enhanced recovery after surgery(ERAS)following LAA occlusion(LAAO)procedures.CASE SUMMARY The objective for this case was to ensure perioperative safety and accelerate postoperative recovery from LAAO in a patient with mirror-image dextrocardia.ERAS was guided by the theory and practice of nursing care.Atrial fibrillation was diagnosed in a 77-year-old male patient,in whom LAAO was performed.The 2019 guidelines for perioperative care after cardiac surgery recommend that the clinical nursing procedures for patients with LAAO should be optimized to reduce the incidence of perioperative complications and ensure patient safety.Music therapy can be used throughout perioperative treatment and nursing to improve the anxiety symptoms of patients.CONCLUSION The procedure was uneventful and proceeded without complications.Anxiety symptoms were improved.展开更多
Background:Left atrial appendage closure(LAAC)with simultaneous interventional occlusion therapy for congenital interatrial communication has become a new focus of patients with nonvalvular atrial fibrillation.Little ...Background:Left atrial appendage closure(LAAC)with simultaneous interventional occlusion therapy for congenital interatrial communication has become a new focus of patients with nonvalvular atrial fibrillation.Little is known about the results of mid-and long-term results.Objective:The aim of this study was to evaluate the midand long-term safety and effectiveness of simultaneous transcatheter closure of the left atrial appendage(LAA)and congenital interatrial communication closure in atrial fibrillation(AF)patients.Methods:From Jan 2016 to June 2017,27 patients with AF were treated with simultaneous transcatheter closure of the LAA and atrial septal defect(ASD,n=22),patent foramen ovale(PFO,n=5).Results:The perioperative closure success rate was 96.3%,except for cardiac tamponade occurred in one ASD patient.During the median 37.6-month follow-up period,no cases of cerebrovascular or peripheral vascular embolism,bleeding,infective endocarditis or thrombosis along the occluders were observed.Of the 21 patients with NYHA Class III,nineteen had significant improvements to NYHA Classes I or II,and 81.5%of patients were free from major or minor adverse events during midand long-term follow-up.Conclusions:Simultaneous closure of the LAA and congenital interatrial communication closure is a viable option for patients with nonvalvular atrial fibrillation who are at risk of stroke or systemic embolism,and it is effective and yields excellent mid-and long-term results.展开更多
Atrial fibrillation prevalence is increasing with age, reaching up to 5% of patients older than 65 years, and is associated with 20%-30% of stroke episodes in that population.
BACKGROUND In patients who suffer from both atrial fibrillation(AF)and atrial septal defect(ASD),cryoballoon pulmonary vein isolation(PVI),sequential left atrial appendage(LAA)occlusion and ASD closure could be a stra...BACKGROUND In patients who suffer from both atrial fibrillation(AF)and atrial septal defect(ASD),cryoballoon pulmonary vein isolation(PVI),sequential left atrial appendage(LAA)occlusion and ASD closure could be a strategy for effective prevention of stroke and right heart failure.CASE SUMMARY A 65-year-old man was admitted to our institution due to recurrent episodes of palpitations and shortness of breath for 2 years,which had been worsening over the last 48 h.He had a history of AF,ASD,coronary heart disease with stent implantation and diabetes.Physical and laboratory examinations showed no abnormalities.The score of CHA2DS2VASc was 3,and HAS-BLED was 1.Echocardiography revealed a 25-mm secundum ASD.Pulmonary vein(PV)and LAA anatomy were assessed by cardiac computed tomography.PV mapping with 10-pole Lasso catheter was performed following ablation of all four PVs with complete PVI.Following the cryoballoon PVI,the patient underwent LAA occlusion under transesophageal echocardiographic monitoring.Lastly,a 34-mm JIYI ASD occlude device was implanted.A follow-up transesophageal echocardiography at 3 mo showed proper position of both devices and neither thrombi nor leakage was found.CONCLUSION Sequential cryoballoon PVI and LAA occlusion prior to ASD closure can be performed safely in AF patients with ASD.展开更多
In this issue of Journal of Geriatric Cardiology, Dr.Piotrowski and colleagues explored the function of the left atrial appendage (LAA)-a small, blind-ended structure of the heart which has been often ignored by cardi...In this issue of Journal of Geriatric Cardiology, Dr.Piotrowski and colleagues explored the function of the left atrial appendage (LAA)-a small, blind-ended structure of the heart which has been often ignored by cardiologists.展开更多
For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-ter...For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-term oral anticoagulation.Incomplete closure of the LAAC during the procedure leads to faster blood flow in the interstitial space around the device,resulting in peri-device leak(PDL),which is not uncommon.Studies are still inconclusive in determining the incidence,long-term safety,and management of PDL.Therefore,this article reviewed the progress made in the research and treatment of PDL after LAAC.展开更多
Atrial fibrillation(AF),the most common sustained cardiac arrhythmia,is increasing in incidence and prevalence worldwide.AF significantly increases the risk of intracardiac thrombus formation and,if left untreated,isc...Atrial fibrillation(AF),the most common sustained cardiac arrhythmia,is increasing in incidence and prevalence worldwide.AF significantly increases the risk of intracardiac thrombus formation and,if left untreated,ischemic stroke.In patients with nonvalvular AF(NVAF),the left atrial appendage(LAA)has been determined to be the source of thrombus development in 91%to 99%of cases.In this regard,oral anticoagulants(OACs)have become the standard treatment for stroke prevention in most patients with AF;however,OACs are associated with a risk of bleeding com-plications,and their efficacy depends on optimal patient compliance.Among alternative approaches to embolic stroke prevention,surgical LAA excision for stroke prevention for valvular AF was attempted as early as the late 1940s.LAA excision remains recommended in surgical guidelines for patients with NVAF requiring open-heart coronary bypass or valvular replacement/repair surgeries.However,owing to the traumatic/invasive nature and suboptimal outcomes of conventional surgical LAA intervention,clinical application of this approach is limited in current cardiology practice.Percutaneous LAA occlusion(LAAO)is increasingly being performed as an alternative to OAC for stroke prevention,particularly in patients with elevated bleeding risk.Substantial progress has been made in percutaneous LAAO therapy since its inception approximately 20 years ago.This article systematically reviews the literature leading to the development of LAAO and the evidence-based clinical experience supporting the application of this treatment strategy for NVAF,with a focus on recently published critical evaluations of US FDA and CE mark approved LAAO devices.Future perspectives regarding knowledge and technol-ogy gaps are also discussed,recognizing the many ongoing clinical trials that are likely to be transformative and the critical unanswered questions regarding LAAO therapy.展开更多
Objective To assess the efficacy and safety of“onestop”procedures combining radiofrequency catheter ablation and left atrial appendage closure by guidance of intracardiac echocardiography(ICE)in elderly patients wit...Objective To assess the efficacy and safety of“onestop”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 ICEguided“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,perioperative 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 complicationsand atrial fibrillation recurrence.Results A total of 213 atrial fibrillationpatientswereenrolled,including 158(74.18%)in the elderly group(age:(68.3±5.0)years;56.96%male)and 55(25.82%)in the nonelderly 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).CHA,DS-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).latrogenic 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 perioperative complications and atrial fibrllation 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.展开更多
Background and objectives Although left atrial appendage closure(LAAC)is performed in patients with non-valvular atrial fibrillation(NVAF)at increased risk of intracranial haemorrhage(ICH),outcome data are scarce.We a...Background and objectives Although left atrial appendage closure(LAAC)is performed in patients with non-valvular atrial fibrillation(NVAF)at increased risk of intracranial haemorrhage(ICH),outcome data are scarce.We assessed the detailed neurological indications for LAAC and outcomes after LAAC in high ICH risk patients.Methods Study population included consecutive patients with NVAF who underwent LAAC in a single hospital network between January 2015 and October 2021 because of prior ICH or the presence of high ICH risk imaging markers on brain MRI(cerebral microbleeds(CMBs)).Primary safety and efficacy outcome measures were the occurrence of ICH and thromboembolic events,respectively,after LAAC.Results Among 146 patients with NVAF who underwent LAAC for high ICH risk,122 had a history of ICH,while 24 presented with high ICH risk imaging markers only.Mean age was 75.7±7.61,42(28.8%)were women.Mean CHA2DS2-VASc score was 5.23±1.52.Of 122 patients with ICH history,58(47.5%)had intraparenchymal haemorrhage(IPH),40(32.8%)had traumatic ICH(T-ICH)and 18(14.7%)had non-traumatic subdural haemorrhage.Of 85 patients with brain MRIs including necessary sequences,43(50.6%)were related to cerebral amyloid angiopathy and 37(43.5%)to hypertensive microangiopathy.While 70%of patients were discharged on oral anticoagulants(OAC),92%were not taking OAC at 1 year.Over 2.12 years mean follow-up,one patient had recurrent non-traumatic IPH(incidence rate(IR)0.32 per 100 patient-years),five had T-ICH(IR 1.61 per 100 patient-years)and six had an ischaemic stroke(IR 1.94 per 100 patient-years).Conclusions Among patients with NVAF at high ICH risk,LAAC demonstrated a low risk of recurrent ICH or ischaemic stroke compared with previously published data.LAAC in high ICH risk populations should be considered in clinical practice per FDA approval and recent guidelines.展开更多
background The occurrence of acute ischaemic stroke(AIS)while using oral anticoagulants(OAC)is an increasingly recognised problem among nonvalvular atrial fibrillation(NVAF)patients.We aimed to elucidate the potential...background The occurrence of acute ischaemic stroke(AIS)while using oral anticoagulants(OAC)is an increasingly recognised problem among nonvalvular atrial fibrillation(NVAF)patients.We aimed to elucidate the potential role of left atrial appendage closure(LAAC)for stroke prevention in patients with AIS despite OAC use(AIS-despite OAC).Methods We retrospectively collected baseline and follow-up data from consecutive NVAF patients who had AIS-despite OAC and subsequently underwent endovascular LAAC,between January 2015 and October 2021.The primary outcome measure was the occurrence of AIS after LAAC,and the safety outcome was symptomatic intracerebral haemorrhage(ICH).results 29 patients had LAAC specifically because of AIS-despite OAC.The mean age at the time of the procedure was 73.4±8.7,13 were female(44.82%).The mean CHA2DS2-VASc score was 5.96±1.32,with an expected AIS risk of 8.44 per 100 patient-years.14 patients(48%)had two or more past AIS-despite OAC.After LAAC,27 patients(93.10%)were discharged on OAC which was discontinued in 17(58.62%)after transoesophageal echocardiogram at 6 weeks.Over a mean of 1.75±1.0 years follow-up after LAAC,one patient had an AIS(incidence rate(IR)1.97 per 100 patient-years).One patient with severe cerebral microangiopathy had a small ICH while on direct OAC and antiplatelet 647 days after LAAC.Conclusions LAAC in AIS-despite OAC patients demonstrated a low annual AIS recurrence rate in our cohort(1.97%)compared with the expected IR based on their CHA2DS2-VASc scores(8.44%)and to recent large series of AIS-despite OAC patients treated with OAC/aspirin only(5.3%-8.9%).These hypothesis-generating findings support randomised trials of LAAC in AIS-despite OAC patients.展开更多
Objective:To explore the diagnosis value of a low dose,dual-energy cardiac computed tomography angiography(CTA)with non-electrocardiography-gated(non-ECG-gated)in detecting left atrial appendage(IAA)thrombus.Methods:C...Objective:To explore the diagnosis value of a low dose,dual-energy cardiac computed tomography angiography(CTA)with non-electrocardiography-gated(non-ECG-gated)in detecting left atrial appendage(IAA)thrombus.Methods:Consecutive patients with atrial fibrillation who underwent cardiac CTA protocol(dual-energy scan for arterial phase and conventional scan for delayed phase)were prospectively enrolled.LAA lesions were proved by clinical comprehensive diagnosis,the final study included 18 cases with LAA thrombus and 48 cases with circulatory stasis.Quantitative parameters derived from dual-energy images were measured for the LAA lesions,including the conventional CT attenuation value(CT value),iodine concentration(IC),normalized iodine concentration(NIC),effective atomic number values(Zeff)and energy spectrum curve slope(Slope).The differences between LAA thrombus group and circulatory stasis group were compared by independent sample t-test or Wilcoxon rank sum test regarding to the normality test.The diagnosis performance of the dual-energy parameters was assessed using receiver operating characteristic(ROC)curve analysis and area under curve(AUC).Results:All the dual-energy parameters were demonstrated significantly difference between LAA thrombus and circulatory stasis group(P<0.05),and showed better diagnostic performance than the conventional CT value.ROC analysis revealed IC was the most predictive parameter with AUC equal to 0.836.The radiation dose in the arterial phase was(2.640.66)mSv.Conclusion:Dual-energy CTA scanning shows convincing diagnostic performance in detecting left atrial appendage thrombus with lower radiation dose,and may help reduce the need for delayed phase scan.展开更多
Background:Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure(LAAC)is increasingly used for stroke prevention in patients with atrial fibrillation(AF).We aimed to observe the fe...Background:Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure(LAAC)is increasingly used for stroke prevention in patients with atrial fibrillation(AF).We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single(one-stop)procedure.Methods:Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled.Baseline and intra-procedural parameters were evaluated.Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects,respectively.Results:A total of 178 AF patients(94 males,68.9±8.1 years)underwent the one-stop procedure with CHA2DS2-VASc score 3.3±1.5 and HAS-BLED score 1.6±1.0,respectively.Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary,yielding immediate ablation success rate of 98.9%(176/178).In the subsequent LAAC,satisfactory seal(residual leak<5 mm)was achieved in all patients.One stroke and four cardiac perforations occurred peri-operatively.At 3-month follow-up,sinus rhythm and satisfactory seal were maintained in 153/178(86.0%)and 178/178(100%)patients,respectively.One stroke and one delayed cardiac tamponade occurred,while no device-related thrombus or device migration was observed.During the 1-year follow-up for the earlier enrolled subjects,52/72(72.2%)of the patients maintained sinus rhythm.There was no stroke or systemic embolism observed.Conclusion:Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.展开更多
Background The left atrial appendage （LAA） is thought to be the main source of thrombi in patients with atrial fibrillation （AF）. The purpose of this study was to describe the LAA orifice diameter, LAA length, and...Background The left atrial appendage （LAA） is thought to be the main source of thrombi in patients with atrial fibrillation （AF）. The purpose of this study was to describe the LAA orifice diameter, LAA length, and morphologic type of the LAA in Chinese patients with AF as well as to evaluate whether these LAA parameters are associated with a history of stroke in patients with AF from a single center in China. Methods The study population consisted of 219 consecutive patients with drug-refractory, symptomatic paroxysmal, or persistent AF scheduled to undergo radiofrequency catheter ablation in our single center. All patients underwent extensive clinical assessment and multidetector computed tomography to fully explore the anatomy of the LAA. Results Of the 219 patients who underwent catheter ablation procedures, chicken wing LAA morphology was found in 114 patients （52.2%）, windsock in 52 （23.9%）, cauliflower in 29 （13.0%）, and cactus in 24 （10.9%）. Compared with the windsock LAA morphology, cactus had a larger left atrial diameter （（42.40±3.68） and （37.91±4.32） mm, P=-0.005） and LAA orifice diameter （（27.38±3.70） and （24.14±3.58） mm, P=0.048）. The LAA length was significantly larger in the chicken wing morphology than in the windsock （（37.50±6.74） and （31.33±3.92） ram, P=0.015） and cauliflower morphologies （（37.50±6.74） and （31.33±3.92） mm, P=-0.015）. According to their medical records, 26 patients （11.9%） had suffered a prior stroke. Compared with patients who had no history of stroke, the prior-stroke patients were older （62.04±8.07 and 58.24±9,24, P=-0.047） and there were fewer patients with chicken wing （23.1% and 59.1%, P=-0.001） and more patients with cauliflower （26.9% and 9.8%, P=-0.046）. Multivariate Logistic regression analysis demonstrated that age （odds ratio （OR） 1.26; 95% confidence interval （CI） 1.08-1.47; P=0.003）, non-chicken wing morphology （OR 5.82; 95% CI 1.61- 21.03; P=-0.007）, and LAA orifice diameter （OR 1.25; 95% CI 1.05-1.49; P=0.014） were independent predictors of stroke after adjusting for all parameters that emerged as potential confounders with univariate analysis. Conclusion LAA analysis can potentially be used to inform guidance on the implication for stroke risk assessment.展开更多
文摘Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.
文摘BACKGROUND There are very few cases of cardiac occluder detachment,and it is rare to completely remove the occluder using interventional methods without undergoing thoracotomy surgery after detachment.This case innovatively used ultrasound guidance combined with digital subtraction angiography(DSA)to completely remove the occluder,accumulating some experience.CASE SUMMARY The patient underwent left atrial appendage occlusion surgery in our hospital due to atrial fibrillation.After the surgery,the occluder fell off and became free in the left ventricle,which is very dangerous.We innovatively used ultrasound guidance,combined with DSA,and interventional surgery to successfully capture the free occluder using a catcher,completely remove it,and then re implant a new left atrial appendage occluder.After the surgery,the patient recovered very well.CONCLUSION The size selection of the occluder is slightly conservative,and the shape of the left atrial appendage opening is irregular.
基金Public Welfare Technology Project of Ningbo Science and Technology Bureau,No.2023S140Medical Health Science and Technology Project of Zhejiang Province Health Commission,No.2024KY1518.
文摘BACKGROUND Inflammatory indices derived from complete blood tests have been reported to be associated with poor outcomes in patients with atrial fibrillation(AF).The data about the relationship between inflammatory indices and left atrial appendage thrombus(LAAT)or dense spontaneous echo contrast(SEC)are limited.AIM To explore the value of inflammatory indices for predicting the presence of LAAT or dense SEC in nonvalvular AF patients.METHODS A total of 406 patients with nonvalvular AF who underwent transesophageal echocardiography were included and divided into two groups based on the presence(study group)or absence(control group)of LAAT or dense SEC.Inflammatory indices,including the neutrophil-to-lymphocyte ratio(NLR),platelet–tolymphocyte ratio(PLR),and lymphocyte-to-monocyte ratio(LMR),were calculated from complete blood analysis.The associations of inflammatory indices RESULTS LAAT and dense SEC were detected in 11(2.7%)and 42(10.3%)patients,respectively.The PLR only showed an association with LAAT/dense SEC in the univariate model.Elevated NLR(odds ratio[OR]=1.48,95%confidence interval[CI]:1.11-1.98,P=0.007)and reduced LMR(OR=0.59,95%CI:0.41-0.83,P=0.003)were found to be independent risk factors for the presence of LAAT/dense SEC.The areas under the NLR and LMR curves for predicting LAAT/dense SEC were 0.73(95%CI:0.66-0.80,P<0.001)and 0.73(95%CI:0.65-0.81,P<0.001),respectively,while the cutoff values were 2.8(sensitivity:69.8%;specificity:64.0%)and 2.4(sensitivity:71.7%;specificity:60.6%),respectively.CONCLUSION Increased NLR and decreased LMR may predict LAAT/dense SEC in patients with nonvalvular AF.
基金Supported by no external funding.Dr.Benditt is supported in part by a grant from the Dr.Earl E Bakken family in support of heart-brain research
文摘AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO)during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery.Clinical outcomes during follow-up included:embolic events,stroke,all-cause mortality,atrial fibrillation(AF),reoperation for bleeding and postoperative complications.We further stratified the analysis based on propensity matched studies and AF predominance.RESULTS Twelve studies(n=40107)met the inclusion criteria.s-LAAO was associated with lower risk of embolic events(OR:0.63,95%CI:0.53-0.76;P<0.001)and stroke(OR:0.68,95%CI:0.57-0.82;P<0.0001).Stratified analysis demonstrated this association was more prominent in the AF predominant strata.There was no significant difference in the incidence risk of allcause mortality,AF,and reoperation for bleeding and postoperative complications.CONCLUSION Concomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke,especially in those with AF without significant increase in adverse events.Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.
文摘Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients with contraindications to chronic oral anticoagulation. The promise of this new intervention compared with warfarin has been supported by several, small studies and two pivotal randomized trial with the Watchman Device. The results regarding risk reduction for stroke have been favourable although acute complications were not infrequent. Procedural complications, which are mainly related to transseptal puncture and device implantation, include air embolism, pericardial effusions/tamponade and device embolization. Knowledge of nature, management and prevention of complications should minimize the risk of complications and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke.
文摘Non-valvular atrial fibrillation is associated with a significantly increased risk of embolic stroke due to blood clot forming predominantly in the left atrial appendage(LAA). Preventive measures to avoid embolic events are permanent administration of anticoagulants or surgical closure of the LAA. Various clinical trials provide evidence about safety, effectiveness and therapeutic success of LAA occlusion using various cardiac occluder devices. The use of such implants for interventional closure of the LAA is likely to become a valuable alternative for stroke prevention, especially in patients with contraindication for oral anticoagulation as safety, clinical benefit and cost-effectiveness of LAA occlusion has recently been demonstrated.
基金supported by the Ph.D. Launch Programs Foundation of Liaoning Province (2019-BS-266)
文摘Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of stroke or systemic embolism.[1]Abnormal hemodynamic changes in elder atrial septal defect(ASD)patients cause remodeling of the left atrium,which eventually leads to right heart failure.[2]As the ASDs elderly are associated with a higher incidence of AF,simultaneous transcatheter ASD and LAA closure has become a new effective therapeutic strategy.However,only a limited number of articles involving cardiac tamponade complications have been published in the literature.What’s more,previous studies involving early hemodynamically irrelevant pericardial effusion after the procedure attribute to multiple repositioning attempts of LAA occluder or delivery sheath injured the atrial wall.
基金Supported by Pudong New Area Science and Technology Development Fund Livelihood Scientific Research Project:Medical and Health,No.PKJ2020-Y106Shanghai Pudong New District Medical Discipline Construction Project C Cardiovascular Internal Medicine Clinical Plateau Discipline,No.PWYgy2018-03+1 种基金Shanghai Key Medical Specialty Construction Project,No.ZK2019B25Scientific Research Project of Shanghai Municipal Health and Family Planning Commission(Youth Project),No.20184Y0230.
文摘BACKGROUND In mirror-image dextrocardia,the anterior-posterior position of the cardiac chambers and great vessels is maintained,but the left-right orientation of the abdominal organs is reversed.The abnormal anatomy of the heart poses surgical challenges and problems in dealing with surgical risk and monitoring complications.There are few reports on closure of the left atrial appendage(LAA)in dextrocardia and no reports on the application of enhanced recovery after surgery(ERAS)following LAA occlusion(LAAO)procedures.CASE SUMMARY The objective for this case was to ensure perioperative safety and accelerate postoperative recovery from LAAO in a patient with mirror-image dextrocardia.ERAS was guided by the theory and practice of nursing care.Atrial fibrillation was diagnosed in a 77-year-old male patient,in whom LAAO was performed.The 2019 guidelines for perioperative care after cardiac surgery recommend that the clinical nursing procedures for patients with LAAO should be optimized to reduce the incidence of perioperative complications and ensure patient safety.Music therapy can be used throughout perioperative treatment and nursing to improve the anxiety symptoms of patients.CONCLUSION The procedure was uneventful and proceeded without complications.Anxiety symptoms were improved.
基金This study was supported by grants from National Natural Science Foundation of China(81870367)Doctoral Start-up Foundation of Liaoning Province of China(2019-BS-266).
文摘Background:Left atrial appendage closure(LAAC)with simultaneous interventional occlusion therapy for congenital interatrial communication has become a new focus of patients with nonvalvular atrial fibrillation.Little is known about the results of mid-and long-term results.Objective:The aim of this study was to evaluate the midand long-term safety and effectiveness of simultaneous transcatheter closure of the left atrial appendage(LAA)and congenital interatrial communication closure in atrial fibrillation(AF)patients.Methods:From Jan 2016 to June 2017,27 patients with AF were treated with simultaneous transcatheter closure of the LAA and atrial septal defect(ASD,n=22),patent foramen ovale(PFO,n=5).Results:The perioperative closure success rate was 96.3%,except for cardiac tamponade occurred in one ASD patient.During the median 37.6-month follow-up period,no cases of cerebrovascular or peripheral vascular embolism,bleeding,infective endocarditis or thrombosis along the occluders were observed.Of the 21 patients with NYHA Class III,nineteen had significant improvements to NYHA Classes I or II,and 81.5%of patients were free from major or minor adverse events during midand long-term follow-up.Conclusions:Simultaneous closure of the LAA and congenital interatrial communication closure is a viable option for patients with nonvalvular atrial fibrillation who are at risk of stroke or systemic embolism,and it is effective and yields excellent mid-and long-term results.
文摘Atrial fibrillation prevalence is increasing with age, reaching up to 5% of patients older than 65 years, and is associated with 20%-30% of stroke episodes in that population.
基金Supported by Taizhou People’s Hospital Scientific Research Start-Up Fund Project,No. QDJJ202113
文摘BACKGROUND In patients who suffer from both atrial fibrillation(AF)and atrial septal defect(ASD),cryoballoon pulmonary vein isolation(PVI),sequential left atrial appendage(LAA)occlusion and ASD closure could be a strategy for effective prevention of stroke and right heart failure.CASE SUMMARY A 65-year-old man was admitted to our institution due to recurrent episodes of palpitations and shortness of breath for 2 years,which had been worsening over the last 48 h.He had a history of AF,ASD,coronary heart disease with stent implantation and diabetes.Physical and laboratory examinations showed no abnormalities.The score of CHA2DS2VASc was 3,and HAS-BLED was 1.Echocardiography revealed a 25-mm secundum ASD.Pulmonary vein(PV)and LAA anatomy were assessed by cardiac computed tomography.PV mapping with 10-pole Lasso catheter was performed following ablation of all four PVs with complete PVI.Following the cryoballoon PVI,the patient underwent LAA occlusion under transesophageal echocardiographic monitoring.Lastly,a 34-mm JIYI ASD occlude device was implanted.A follow-up transesophageal echocardiography at 3 mo showed proper position of both devices and neither thrombi nor leakage was found.CONCLUSION Sequential cryoballoon PVI and LAA occlusion prior to ASD closure can be performed safely in AF patients with ASD.
文摘In this issue of Journal of Geriatric Cardiology, Dr.Piotrowski and colleagues explored the function of the left atrial appendage (LAA)-a small, blind-ended structure of the heart which has been often ignored by cardiologists.
基金Supported by Zhejiang Provincial Foundation for Medical and Health Sciences,No.2021KY980.
文摘For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-term oral anticoagulation.Incomplete closure of the LAAC during the procedure leads to faster blood flow in the interstitial space around the device,resulting in peri-device leak(PDL),which is not uncommon.Studies are still inconclusive in determining the incidence,long-term safety,and management of PDL.Therefore,this article reviewed the progress made in the research and treatment of PDL after LAAC.
文摘Atrial fibrillation(AF),the most common sustained cardiac arrhythmia,is increasing in incidence and prevalence worldwide.AF significantly increases the risk of intracardiac thrombus formation and,if left untreated,ischemic stroke.In patients with nonvalvular AF(NVAF),the left atrial appendage(LAA)has been determined to be the source of thrombus development in 91%to 99%of cases.In this regard,oral anticoagulants(OACs)have become the standard treatment for stroke prevention in most patients with AF;however,OACs are associated with a risk of bleeding com-plications,and their efficacy depends on optimal patient compliance.Among alternative approaches to embolic stroke prevention,surgical LAA excision for stroke prevention for valvular AF was attempted as early as the late 1940s.LAA excision remains recommended in surgical guidelines for patients with NVAF requiring open-heart coronary bypass or valvular replacement/repair surgeries.However,owing to the traumatic/invasive nature and suboptimal outcomes of conventional surgical LAA intervention,clinical application of this approach is limited in current cardiology practice.Percutaneous LAA occlusion(LAAO)is increasingly being performed as an alternative to OAC for stroke prevention,particularly in patients with elevated bleeding risk.Substantial progress has been made in percutaneous LAAO therapy since its inception approximately 20 years ago.This article systematically reviews the literature leading to the development of LAAO and the evidence-based clinical experience supporting the application of this treatment strategy for NVAF,with a focus on recently published critical evaluations of US FDA and CE mark approved LAAO devices.Future perspectives regarding knowledge and technol-ogy gaps are also discussed,recognizing the many ongoing clinical trials that are likely to be transformative and the critical unanswered questions regarding LAAO therapy.
文摘Objective To assess the efficacy and safety of“onestop”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 ICEguided“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,perioperative 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 complicationsand atrial fibrillation recurrence.Results A total of 213 atrial fibrillationpatientswereenrolled,including 158(74.18%)in the elderly group(age:(68.3±5.0)years;56.96%male)and 55(25.82%)in the nonelderly 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).CHA,DS-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).latrogenic 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 perioperative complications and atrial fibrllation 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.
文摘Background and objectives Although left atrial appendage closure(LAAC)is performed in patients with non-valvular atrial fibrillation(NVAF)at increased risk of intracranial haemorrhage(ICH),outcome data are scarce.We assessed the detailed neurological indications for LAAC and outcomes after LAAC in high ICH risk patients.Methods Study population included consecutive patients with NVAF who underwent LAAC in a single hospital network between January 2015 and October 2021 because of prior ICH or the presence of high ICH risk imaging markers on brain MRI(cerebral microbleeds(CMBs)).Primary safety and efficacy outcome measures were the occurrence of ICH and thromboembolic events,respectively,after LAAC.Results Among 146 patients with NVAF who underwent LAAC for high ICH risk,122 had a history of ICH,while 24 presented with high ICH risk imaging markers only.Mean age was 75.7±7.61,42(28.8%)were women.Mean CHA2DS2-VASc score was 5.23±1.52.Of 122 patients with ICH history,58(47.5%)had intraparenchymal haemorrhage(IPH),40(32.8%)had traumatic ICH(T-ICH)and 18(14.7%)had non-traumatic subdural haemorrhage.Of 85 patients with brain MRIs including necessary sequences,43(50.6%)were related to cerebral amyloid angiopathy and 37(43.5%)to hypertensive microangiopathy.While 70%of patients were discharged on oral anticoagulants(OAC),92%were not taking OAC at 1 year.Over 2.12 years mean follow-up,one patient had recurrent non-traumatic IPH(incidence rate(IR)0.32 per 100 patient-years),five had T-ICH(IR 1.61 per 100 patient-years)and six had an ischaemic stroke(IR 1.94 per 100 patient-years).Conclusions Among patients with NVAF at high ICH risk,LAAC demonstrated a low risk of recurrent ICH or ischaemic stroke compared with previously published data.LAAC in high ICH risk populations should be considered in clinical practice per FDA approval and recent guidelines.
文摘background The occurrence of acute ischaemic stroke(AIS)while using oral anticoagulants(OAC)is an increasingly recognised problem among nonvalvular atrial fibrillation(NVAF)patients.We aimed to elucidate the potential role of left atrial appendage closure(LAAC)for stroke prevention in patients with AIS despite OAC use(AIS-despite OAC).Methods We retrospectively collected baseline and follow-up data from consecutive NVAF patients who had AIS-despite OAC and subsequently underwent endovascular LAAC,between January 2015 and October 2021.The primary outcome measure was the occurrence of AIS after LAAC,and the safety outcome was symptomatic intracerebral haemorrhage(ICH).results 29 patients had LAAC specifically because of AIS-despite OAC.The mean age at the time of the procedure was 73.4±8.7,13 were female(44.82%).The mean CHA2DS2-VASc score was 5.96±1.32,with an expected AIS risk of 8.44 per 100 patient-years.14 patients(48%)had two or more past AIS-despite OAC.After LAAC,27 patients(93.10%)were discharged on OAC which was discontinued in 17(58.62%)after transoesophageal echocardiogram at 6 weeks.Over a mean of 1.75±1.0 years follow-up after LAAC,one patient had an AIS(incidence rate(IR)1.97 per 100 patient-years).One patient with severe cerebral microangiopathy had a small ICH while on direct OAC and antiplatelet 647 days after LAAC.Conclusions LAAC in AIS-despite OAC patients demonstrated a low annual AIS recurrence rate in our cohort(1.97%)compared with the expected IR based on their CHA2DS2-VASc scores(8.44%)and to recent large series of AIS-despite OAC patients treated with OAC/aspirin only(5.3%-8.9%).These hypothesis-generating findings support randomised trials of LAAC in AIS-despite OAC patients.
基金the Scientific Research Fund of Joint Construction Project of Henan Province and Ministry of Medical Science and Technology(No.SB201901097)ChinaHenan Provincial Key Laboratory of Cardiology Medical Imaging(No.2021-44-16),China.
文摘Objective:To explore the diagnosis value of a low dose,dual-energy cardiac computed tomography angiography(CTA)with non-electrocardiography-gated(non-ECG-gated)in detecting left atrial appendage(IAA)thrombus.Methods:Consecutive patients with atrial fibrillation who underwent cardiac CTA protocol(dual-energy scan for arterial phase and conventional scan for delayed phase)were prospectively enrolled.LAA lesions were proved by clinical comprehensive diagnosis,the final study included 18 cases with LAA thrombus and 48 cases with circulatory stasis.Quantitative parameters derived from dual-energy images were measured for the LAA lesions,including the conventional CT attenuation value(CT value),iodine concentration(IC),normalized iodine concentration(NIC),effective atomic number values(Zeff)and energy spectrum curve slope(Slope).The differences between LAA thrombus group and circulatory stasis group were compared by independent sample t-test or Wilcoxon rank sum test regarding to the normality test.The diagnosis performance of the dual-energy parameters was assessed using receiver operating characteristic(ROC)curve analysis and area under curve(AUC).Results:All the dual-energy parameters were demonstrated significantly difference between LAA thrombus and circulatory stasis group(P<0.05),and showed better diagnostic performance than the conventional CT value.ROC analysis revealed IC was the most predictive parameter with AUC equal to 0.836.The radiation dose in the arterial phase was(2.640.66)mSv.Conclusion:Dual-energy CTA scanning shows convincing diagnostic performance in detecting left atrial appendage thrombus with lower radiation dose,and may help reduce the need for delayed phase scan.
基金This work was supported by grants from the State Key Program of National Natural Science Foundation of China(No.81530015)Clinical Research Plan of SHDC(No.16CR2019A).
文摘Background:Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure(LAAC)is increasingly used for stroke prevention in patients with atrial fibrillation(AF).We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single(one-stop)procedure.Methods:Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled.Baseline and intra-procedural parameters were evaluated.Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects,respectively.Results:A total of 178 AF patients(94 males,68.9±8.1 years)underwent the one-stop procedure with CHA2DS2-VASc score 3.3±1.5 and HAS-BLED score 1.6±1.0,respectively.Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary,yielding immediate ablation success rate of 98.9%(176/178).In the subsequent LAAC,satisfactory seal(residual leak<5 mm)was achieved in all patients.One stroke and four cardiac perforations occurred peri-operatively.At 3-month follow-up,sinus rhythm and satisfactory seal were maintained in 153/178(86.0%)and 178/178(100%)patients,respectively.One stroke and one delayed cardiac tamponade occurred,while no device-related thrombus or device migration was observed.During the 1-year follow-up for the earlier enrolled subjects,52/72(72.2%)of the patients maintained sinus rhythm.There was no stroke or systemic embolism observed.Conclusion:Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.
基金This study was supported by grants from the Key Project of Hubei Science and Technology Support Program （No. 2013BCB013）, the Key Project of Hubei Natural Science Foundation （No. 2013CFA059）, and the National Natural Science Foundation of China （No. 81270249）.
文摘Background The left atrial appendage （LAA） is thought to be the main source of thrombi in patients with atrial fibrillation （AF）. The purpose of this study was to describe the LAA orifice diameter, LAA length, and morphologic type of the LAA in Chinese patients with AF as well as to evaluate whether these LAA parameters are associated with a history of stroke in patients with AF from a single center in China. Methods The study population consisted of 219 consecutive patients with drug-refractory, symptomatic paroxysmal, or persistent AF scheduled to undergo radiofrequency catheter ablation in our single center. All patients underwent extensive clinical assessment and multidetector computed tomography to fully explore the anatomy of the LAA. Results Of the 219 patients who underwent catheter ablation procedures, chicken wing LAA morphology was found in 114 patients （52.2%）, windsock in 52 （23.9%）, cauliflower in 29 （13.0%）, and cactus in 24 （10.9%）. Compared with the windsock LAA morphology, cactus had a larger left atrial diameter （（42.40±3.68） and （37.91±4.32） mm, P=-0.005） and LAA orifice diameter （（27.38±3.70） and （24.14±3.58） mm, P=0.048）. The LAA length was significantly larger in the chicken wing morphology than in the windsock （（37.50±6.74） and （31.33±3.92） ram, P=0.015） and cauliflower morphologies （（37.50±6.74） and （31.33±3.92） mm, P=-0.015）. According to their medical records, 26 patients （11.9%） had suffered a prior stroke. Compared with patients who had no history of stroke, the prior-stroke patients were older （62.04±8.07 and 58.24±9,24, P=-0.047） and there were fewer patients with chicken wing （23.1% and 59.1%, P=-0.001） and more patients with cauliflower （26.9% and 9.8%, P=-0.046）. Multivariate Logistic regression analysis demonstrated that age （odds ratio （OR） 1.26; 95% confidence interval （CI） 1.08-1.47; P=0.003）, non-chicken wing morphology （OR 5.82; 95% CI 1.61- 21.03; P=-0.007）, and LAA orifice diameter （OR 1.25; 95% CI 1.05-1.49; P=0.014） were independent predictors of stroke after adjusting for all parameters that emerged as potential confounders with univariate analysis. Conclusion LAA analysis can potentially be used to inform guidance on the implication for stroke risk assessment.
