Endocardial versus epicardial left atrial appendage exclusion for stroke prevention in patients with atrial fibrillation: Midterm follow‐up

Litwinowicz, Radosław; Burysz, Marian; Mazur, Piotr; Kapelak, Bogusław; Bartuś, Magdalena; Lakkireddy, Dhanunjaya; Lee, Randall J.; Malec-Litwinowicz, Michalina; Bartuś, Krzysztof

doi:10.1111/jce.14802

Cited by 14 publications

(14 citation statements)

References 40 publications

(123 reference statements)

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“…Endocardial LAAC also demonstrated different concentrations of natriuretic peptides during the follow-up period [ 5 , 9 , 10 ], possibly due to a different extent of leakage around the device and the absence of acute and chronic LAA necrosis. Mechanistically, epicardial LAAC is different from endocardial LAAC [ 11 ]. Epicardial LAAC leads to inflammation of the LAA, which is later followed by fibrosis, scarring, closure, and permanent resorption of the LAA over a prolonged period [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Long Term Impact of Epicardial Left Atrial Appendage Ligation on Systemic Hemostasis: LAA HOMEOSTASIS-2

Bartuś

Kanuri

Litwinowicz

et al. 2022

JCM

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Background: Recent data suggest that epicardial left atrial appendage closure (LAAC) is associated with several short-term neurohormonal effects. However, the long-term effects are currently unknown. Objective: To investigate the effects of percutaneous epicardial left atial appendage (LAA) exclusion using LARIAT on neurohormonal profiles at long-term follow-up. Methods: In a prospective single centre study, 60 patients with long-standing, persistent atrial fibrillation (AF) LARIAT were treated. The major hormones of the adrenergic system, renin-angiotensin-aldosterone system (RAAS), and natriuretic peptides were assessed before the intervention and at regular intervals during the following two years. Results: In patients with epicardial LAAC, atrial natriuretic peptide (ANP) levels were significantly increased from baseline at 24 h and decreased at 7 days, 1 month, and 3 months, while remaining unchanged at 12 and 24 months. Noradrenaline levels were significantly lower at 24 h, 7 days, 1 month, 6 months, 12 months, and 24 months, while epinephrine levels decreased significantly at 1 month, 6 months, 12 months, and 24 months. Plasma renin activity significantly decreased at 7 days, 1 month, 6 months, 12 months, and 24 months, while aldosterone levels significantly decreased at 6 months, 12 months, and 24 months. Endothelin-1 and vasopressin showed a significant increase and decrease, respectively, at 24 h, 7 days, 1 month, 6 months, 12 months, and 24 months. There was also a significant decrease in systolic and diastolic blood pressure at 3 months, 6 months, 1 year, and 2 years after the intervention. Conclusions: Epicardial LAAC in AF patients is associated with persistent neurohormonal changes favouring blood pressure reduction.

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Section: Discussionmentioning

confidence: 99%

Long Term Impact of Epicardial Left Atrial Appendage Ligation on Systemic Hemostasis: LAA HOMEOSTASIS-2

Bartuś

Kanuri

Litwinowicz

et al. 2022

JCM

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“…Recent data has shown good long-term results with acceptable complication rates, even in elderly populations [ 27 ]. The procedure can be performed by endocardial or epicardial approaches with a similar mid-term follow-up [ 28 ]. Results from a nationwide study in the United States indicated that endocardial approach seemed to have a lower complication rate than the epicardial approach [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Predicting the Absolute Risk of Ischemic Stroke in Asian Patients with Atrial Fibrillation: Comparing the COOL-AF Risk Score with CARS/mCARS Models for Absolute Risk and the CHA2DS2-VASc Score

Krittayaphong

Winijkul

Sairat

et al. 2023

JCM

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Background: The aims of this study were (1) to validate the CARS and mCARS methods in an Asian population with atrial fibrillation (AF) and (2) to compare the CARS and mCARS models for absolute risk using the COOL-AF method and CHA2DS2VASc scores for the prediction of ischemic stroke or systemic embolism (SSE). Methods: We analyzed the results from a prospective nationwide multicenter AF registry. Follow-up data were collected for 3 years. The main outcomes were SSE. Predictive models of the 3-year SSE of the COOL-AF model, the CHA2DS2VASc score, the CARS for the no-OAC group, and the mCARS for the OAC group were developed and evaluated by C-statistics, and calibration plots were created for the whole group, as well as for oral anticoagulant (OAC) users and no-OAC patients. Results: We studied 3405 patients (mean age: 67.8 years; 58.2% male, 75.4% OAC). The incidence rates of SSE were 1.51 (1.26–1.78), 1.93 (1.39–2.60), and 1.37 (1.10–1.68) for all patients, no-OAC patients, and OAC patients, respectively. For the whole population, the COOL-AF score had a C-statistic of 0.697 (0.682–0.713), which was superior to the CHA2DS2-VASc [0.655 (0.639–0.671)]. For the no-OAC group, the CARS predicted SSE with a C-statistic of 0.685 (0.652–0.716), which was similar to the CHA2DS2-VASc [0.684 (0.651–0.7150] and COOL-AF models [0.692 (0.659–0.723)]. For the OAC group, the mCARS had a C-statistic of 0.687 (0.669–0.705) that was similar to the COOL-AF [0.704 (0.686–0.721)] and better than the CHA2DS2-VASc score [0.655 (0.637–0.674)]. Conclusions: The calculation of the individual absolute risks using the CARS and mCARS models can predict SSE in an Asian population. Small differences were evident between the COOL-AF and CHA2DS2-VASc scores.

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“…Sealing leaks with occluders may be a reasonable option in this scenario [ 202 ]. Compared to endocardial LAAC devices, the LARIAT system is associated with a higher short-term complication rate [ 203 ], but similar mid-term efficacy [ 204 ]. The second-generation LARIAT + has improved features, such as snare expansion from 40 mm to 45 mm, the addition of a platinum–iridium ‘L’ Marker that allows identification of the device orientation under fluoroscopy, and a stainless steel wire braid on catheter shaft that provides improved ‘torque-ability’ of the catheter.…”

Section: Left Atrial Appendage Closurementioning

confidence: 99%

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

Theofilis

Oikonomou²,

Antonopoulos³

et al. 2022

Biomedicines

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Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, represents a major cause of morbidity and mortality, with an increasing prevalence. Pharmacologic treatment remains the cornerstone of its management through rhythm and rate control, as well as the prevention of thromboembolism with the use of oral anticoagulants. Recent progress in percutaneous interventional approaches have provided additional options in the therapeutic arsenal, however. The use of the different catheter ablation techniques can now lead to long arrhythmia-free intervals and significantly lower AF burden, thus reducing the rate of its complications. Particularly encouraging evidence is now available for patients with persistent AF or concomitant heart failure, situations in which catheter ablation could even be a first-line option. In the field of stroke prevention, targeting the left atrial appendage with percutaneous device implantation may reduce the risk of thromboembolism to lower rates than that predicted with conventional ischemic risk scores. Left atrial appendage occlusion through the approved Watchman or Amplatzer devices is a well-established, efficacious, and safe method, especially in high-ischemic and bleeding risk patients with contraindications for oral anticoagulation.

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Endocardial versus epicardial left atrial appendage exclusion for stroke prevention in patients with atrial fibrillation: Midterm follow‐up

Cited by 14 publications

References 40 publications

Long Term Impact of Epicardial Left Atrial Appendage Ligation on Systemic Hemostasis: LAA HOMEOSTASIS-2

Long Term Impact of Epicardial Left Atrial Appendage Ligation on Systemic Hemostasis: LAA HOMEOSTASIS-2

Predicting the Absolute Risk of Ischemic Stroke in Asian Patients with Atrial Fibrillation: Comparing the COOL-AF Risk Score with CARS/mCARS Models for Absolute Risk and the CHA2DS2-VASc Score

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

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