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
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
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 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
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
The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy(CAA)and atrial fibrilla...The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy(CAA)and atrial fibrillation(AF).In fact,CAA is an age-related cerebral vasculopathy that predisposes patients to intracerebral hemorrhage.Nevertheless,many AF patients require oral systemic dose-adjusted warfarin,direct oral anticoagulants(such as factor Xa inhibitors)or direct thrombin inhibitors to control often associated with cardioembolic stroke risk.The prevalence of both CAA and AF is expected to rise,due to the aging of the population.This clinical dilemma is becoming increasingly common.In patients with coexisting AF and CAA,the risks/benefits profile of anticoagulant therapy must be assessed for each patient individually due to the lack of a clear-cut consensus with regard to its risks in scientific literature.This review aims to provide an overview of the management of patients with concomitant AF and CAA and proposes the implementation of a risk-based decision-making algorithm.展开更多
Background： In patients with nonvalvular atrial fibrillation （NVAF）, embolic stroke is thought to be associated with left atrial appendage （LAA） thrombi. The WATCHMAN LAA Occlusion Device has been shown to be non...Background： In patients with nonvalvular atrial fibrillation （NVAF）, embolic stroke is thought to be associated with left atrial appendage （LAA） thrombi. The WATCHMAN LAA Occlusion Device has been shown to be noninferior to conventional oral anticoagulation with warfarin for stroke prevention in patients with NVAF. This study aimed to evaluate the procedural feasibility, safety and 12-month outcomes of the WATCHMAN LAA Occlusion Device in NVAF patients with high risk for stroke in China. Methods： The clinical data of 106 NVAF patients, who were consecutively underwent LAA closure with the WATCHMAN Device between April 2014 and May 2015, were collected. Patients were followed up at 1,3, 6, and 12 months after discharge. A transesophageal echocardiograph was performed at 45 days after implantation and repeated in case of an unexpected event during the follow-up period. Results： This study included 106 NVAF patients with a mean age of 64.2 ± 8.6 years （ranging from 50 to 88 years）, and the mean CHA,DS,-VASc score of all patients was 3.6 ± 1.6 （ranging from 2 to 9）. Among those 106 NVAF patients, 100 （94.3%） patients were implanted with the device successfully. The procedural success rate was 94.3% （100/106）, and the occlusion rate was 100.0% （100/100）. There were one tamponade, one ischemic stroke, and eight minor pericardial effusions during hospitalization. During 12-month follow-up period, two patients developed a tbrombus layer on the device that resolved with additional anticoagulation： one with visible device-thrombus experienced transient ischemic stroke, and one had a hemorrhagic stroke. There were no deaths in this study. The overall survival rate was 100.0%, and nonmajor adverse event rate was 95.0% （95/100）. In this study, the expected annual rate ofischemic stroke risk in these patients according to the CHA2DS2-VASc score was 4.0%, while the observed ischemic stroke rate was 2.0% per year. Conclusions： LAA closure with the WATCHMAN Device was feasible, efficient, and safe for NVAF to prevent the accidence of stroke in Chinese patients. During the 12-month follow-up period, the observed ischemic stroke rate （2.0% per year） in our study was lower than the predicted annual stroke risk （4.0%） using the CHA2DS：-VASc score.展开更多
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 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.
文摘The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy(CAA)and atrial fibrillation(AF).In fact,CAA is an age-related cerebral vasculopathy that predisposes patients to intracerebral hemorrhage.Nevertheless,many AF patients require oral systemic dose-adjusted warfarin,direct oral anticoagulants(such as factor Xa inhibitors)or direct thrombin inhibitors to control often associated with cardioembolic stroke risk.The prevalence of both CAA and AF is expected to rise,due to the aging of the population.This clinical dilemma is becoming increasingly common.In patients with coexisting AF and CAA,the risks/benefits profile of anticoagulant therapy must be assessed for each patient individually due to the lack of a clear-cut consensus with regard to its risks in scientific literature.This review aims to provide an overview of the management of patients with concomitant AF and CAA and proposes the implementation of a risk-based decision-making algorithm.
文摘Background： In patients with nonvalvular atrial fibrillation （NVAF）, embolic stroke is thought to be associated with left atrial appendage （LAA） thrombi. The WATCHMAN LAA Occlusion Device has been shown to be noninferior to conventional oral anticoagulation with warfarin for stroke prevention in patients with NVAF. This study aimed to evaluate the procedural feasibility, safety and 12-month outcomes of the WATCHMAN LAA Occlusion Device in NVAF patients with high risk for stroke in China. Methods： The clinical data of 106 NVAF patients, who were consecutively underwent LAA closure with the WATCHMAN Device between April 2014 and May 2015, were collected. Patients were followed up at 1,3, 6, and 12 months after discharge. A transesophageal echocardiograph was performed at 45 days after implantation and repeated in case of an unexpected event during the follow-up period. Results： This study included 106 NVAF patients with a mean age of 64.2 ± 8.6 years （ranging from 50 to 88 years）, and the mean CHA,DS,-VASc score of all patients was 3.6 ± 1.6 （ranging from 2 to 9）. Among those 106 NVAF patients, 100 （94.3%） patients were implanted with the device successfully. The procedural success rate was 94.3% （100/106）, and the occlusion rate was 100.0% （100/100）. There were one tamponade, one ischemic stroke, and eight minor pericardial effusions during hospitalization. During 12-month follow-up period, two patients developed a tbrombus layer on the device that resolved with additional anticoagulation： one with visible device-thrombus experienced transient ischemic stroke, and one had a hemorrhagic stroke. There were no deaths in this study. The overall survival rate was 100.0%, and nonmajor adverse event rate was 95.0% （95/100）. In this study, the expected annual rate ofischemic stroke risk in these patients according to the CHA2DS2-VASc score was 4.0%, while the observed ischemic stroke rate was 2.0% per year. Conclusions： LAA closure with the WATCHMAN Device was feasible, efficient, and safe for NVAF to prevent the accidence of stroke in Chinese patients. During the 12-month follow-up period, the observed ischemic stroke rate （2.0% per year） in our study was lower than the predicted annual stroke risk （4.0%） using the CHA2DS：-VASc score.
