Catheter Ablation for Atrial Fibrillation in Patients With Watchman Left Atrial Appendage Occlusion Device: Results from a Multicenter Registry

Section: Discussionsupporting

confidence: 80%

“…6,13,14 Catheter ablation for AF after LAA occlusion appeared feasible and safe in a multicenter registry. 15 Philips et al provide similar results for a combined procedure. 16 In this single-center study, we confirm both find-ings.…”

Section: Procedural Results and Long-term Follow-upmentioning

confidence: 80%

Long‐term follow‐up after left atrial appendage occlusion with comparison of transesophageal echocardiography versus computed tomography to guide medical therapy and data about postclosure cardioversion

Berte

Jost

Maurer

et al. 2017

“…These findings are in contrast to our multicenter CA experience in 60 patients with Watchman device where LAA isolation was challenging due to the device seated at the LAA ostium and resultant significant de novo peridevice leaks postablation in those LAA isolation was attempted. Attempts of ablation around a previously well sealed device can cause endothelial denudation resulting in new leaks . This has tremendous implications to long‐term need for OAC and risk of STE.…”

Section: Discussionmentioning

confidence: 99%

Anatomical and electrical remodeling with incomplete left atrial appendage ligation: Results from the LAALA‐AF registry

Turagam

Atkins

Earnest

et al. 2017

Self Cite

“…LAAC in combination with LAA electrical isolation is feasible when performed by experienced operators . However, high rates of severe peridevice leak have been reported when LAA electrical isolation is performed following LAAC, perhaps due to an effect on LAA geometry and device sizing . The impact of extensive left atrial ablation at the time of LAAC on DRT is unknown, leading experienced operators to recommend a 6‐month waiting period between LAAC and electrical isolation of the LAA .…”

Section: Laac and Doac In Unique Subgroupsmentioning

confidence: 99%

“…60 The impact of extensive left atrial ablation at the time of LAAC on DRT is unknown, leading experienced operators to recommend a 6month waiting period between LAAC and electrical isolation of the LAA. 60 The utility of combined LAAC and LAA electrical isolation will be informed by results from the ongoing WATCH-Rhythm (WATCH-…”

Section: Af Ablation and Left Atrial Appendage Electrical Isolationmentioning

confidence: 99%

Left atrial appendage closure: A therapy uniquely suited for specific populations of patients with atrial fibrillation

Black‐Maier

Piccini

Granger

2019

Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and confers a fivefold increased risk for stroke. Cardioembolic stroke secondary to AF is a devastating event, but is largely preventable with appropriate oral anticoagulation (OAC). The PROTECT and PREVAIL trials demonstrated that the WATCHMAN left atrial appendage closure (LAAC) device in combination with short‐term warfarin therapy is noninferior to long‐term warfarin with respect to a composite endpoint of stroke, cardiovascular death, and systemic embolism. Importantly, the WATCHMAN confers a significant reduction in life‐threatening bleeding compared to OAC. Although direct‐acting oral anticoagulant (DOAC) are superior to warfarin in eligible patients, several important AF populations exist in whom left atrial appendage (LAA) closure may be preferable to DOAC. Populations warranting strong consideration of LAAC include patients with contraindications to DOAC, end‐stage renal disease, prior intracranial hemorrhage, recurrent gastrointestinal bleeding, and patients undergoing transcatheter aortic valve replacement or left atrial electrical isolation. Device‐related thrombosis is an important complication of LAAC, and DOAC may be preferential to warfarin for prevention and treatment of this complication remains unexplored. Prospective clinical trials comparing DOAC to LAAC in these unique populations are either ongoing or needed.