Experience of left atrial appendage closure performed under conscious sedation

Chan, Ngai‐Yin; Lau, Chun-Leung; Tsui, Ping-Tim; Lo, Ying-Keung; Mok, Ngai-Shing

doi:10.1177/0218492314548231

Cited by 19 publications

(12 citation statements)

References 17 publications

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“…To the best of our knowledge, only one case-series describing LAAO under conscious sedation has been published so far. [27] Chan et al . describe their experience in 11 subjects undergoing LAAO under sedation with fentanyl and midazolam, and report no major complications following the procedure.…”

Section: Discussionmentioning

confidence: 99%

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Noninvasive ventilation during left atrial appendage closure under sedation: Preliminary experience with the Janus Mask

et al. 2019

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Background:Percutaneous left atrial appendage occlusion (LAAO) is indicated in subjects with atrial fibrillation who cannot receive oral anticoagulants. This procedure requires transesophageal echocardiography guidance and is usually performed under general anesthesia. The Janus Mask is a new device designed to allow upper endoscopic procedures during noninvasive ventilation (NIV).Aims:This study aims to assess the possibility of performing LAAO under sedation and NIV.Setting:Cardiac electrophysiology laboratory.Design:Case–control study.Materials and Methods:Data from 11 subjects undergoing LAAO under sedation and NIV with the Janus Mask were retrospectively collected. Procedure duration, outcomes, and physicians' satisfaction were compared with those of 11 subjects who underwent LAAO under general anesthesia in the same period.Statistical Analysis:Univariate analysis and analysis of variance for between-groups comparison.Results:The 11 subjects treated with sedation experienced a good outcome, with a high degree of satisfaction from the medical team. An increase in arterial partial pressure of carbon dioxide in the Janus group (45 [43–62] mmHg vs. 33 [30–35] mmHg in the general anesthesia group, P < 0.001) led to a transient pH decrease 45 min after the beginning of the procedure (7.30 [7.18–7.36] vs. 7.40 [7.39–7.46], P = 0.014). No differences in arterial partial pressure of oxygen, FiO2, and hemodynamic parameters were observed. The subjects' conditions at discharge from the recovery room were comparable. No difference in procedure duration was registered.Conclusions:LAAO procedure under sedation and NIV through the Janus Mask is safe and feasible. This strategy might represent a valuable alternative to manage such a compromised and fragile population.

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Section: Discussionmentioning

confidence: 99%

“…In addition, subjects described in their study are younger, with a lower prevalence of comorbidities and better cardiac function (as reflected by the higher mean ejection fraction) as compared with those enrolled in our study. [27]…”

Section: Discussionmentioning

confidence: 99%

Noninvasive ventilation during left atrial appendage closure under sedation: Preliminary experience with the Janus Mask

et al. 2019

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“…Chan et al 31 reported on 11 patients who underwent either a WATCHMAN or an ACP device implantation. Each patient underwent the procedure under conscious sedation with intravenous midazolam and fentanyl as well as continuous TEE monitoring.…”

Section: Preoperative Evaluation For Anesthesiamentioning

confidence: 99%

“…The study showed a 100% success rate for procedure completion and no procedure-related complications from using conscious sedation. 31 Limitations of this study are that it was a small study, it was not randomized with a GETA control group to compare procedure times, and it did not address any metrics for patient satisfaction.…”

Section: Preoperative Evaluation For Anesthesiamentioning

confidence: 99%

Anesthetic Management of Patients Undergoing Percutaneous Endocardial and Epicardial Left Atrial Appendage Occlusion

Husain

Safavi‐Naeini²,

Rasekh³

et al. 2017

Semin Cardiothorac Vasc Anesth

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Atrial fibrillation is the most common cardiac arrhythmia in adults affecting almost 6 million adults in the United States. The 2 most common comorbidities associated with atrial fibrillation are heart failure and thromboembolic events. Heart failure symptoms may be treated with rate control, antiarrhythmic medications or by catheter ablation. Unfortunately, despite optimal medical management, thromboembolic events still occur. Recently, there has been a great deal of interest and innovation in finding an alternative to chronic anticoagulation. Several percutaneous left atrial appendage occlusion devices have been developed over recent years, some of which have proven to be noninferior to anticoagulation in preventing strokes in atrial fibrillation patients. The 2 most widely used left atrial appendage occlusion devices are the WATCHMAN (Atritech Inc, Plymouth, MN, USA) and the LARIAT (SentreHEART, Palo Alto, CA, USA) devices. After a detailed description of the procedures, the anesthetic considerations of each procedure and management of specific adverse events are discussed within this review.

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“…The main advantage of ICE utilization is that it avoids the need for general anaesthesia or deep sedation, which can be associated with additional complications (aspiration, delirium…), lead to longer procedure-time and to additional resource utilization. Of note, a recent small study showed the feasibility of LAA closure using conscious sedation with TOE guidance [60] whereas another study described the use of an ICE-TOE probe through the oesophageal route without general anaesthesia for the monitoring of ACP device implantation [61]. ICE currently lacks multiplanar capabilities and may provide suboptimal imaging of LAA, even though the ability to move the probe in different positions may compensate these shortcomings.…”

Section: Alternative and Future Imaging Mo Dalities Intracardiac Echomentioning

confidence: 99%

Role of Imaging in Left Atrial Appendage Occlusion

Lempereur

Aminian

Potter

et al. 2017

ijcp

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Percutaneous left atrial appendage (LAA) occlusion is now a valid alternative to longterm oral anticoagulation in patients with non-valvular atrial fibrillation at high thromboembolism risk, especially for patients who are considered ineligible for anticoagulation. The most frequently used occluders worldwide include the WATCHAMN (Boston Scientific, Natick, MA, USA) and the Amplatzer Cardiac Plug or Amulet (St. Jude Medical/Abbott, St Paul, MN, USA) devices. Multimodality imaging is key in the understanding of 3D aspects of the LAA and surrounding structures anatomy. Imaging is essential for procedural planning, during each step of the procedure and for device surveillance after implantation. Multimodality imaging, including 2D/3D echocardiography, fluoroscopy, and cardiac computed tomography can increase the safety and efficacy of the procedure.

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Experience of left atrial appendage closure performed under conscious sedation

Abstract: Percutaneous left atrial appendage occlusion can be performed safely and effectively under conscious sedation. This approach will significantly reduce the complexity and costs of this increasingly performed procedure.

Cited by 19 publications

References 17 publications

Noninvasive ventilation during left atrial appendage closure under sedation: Preliminary experience with the Janus Mask

Noninvasive ventilation during left atrial appendage closure under sedation: Preliminary experience with the Janus Mask

Anesthetic Management of Patients Undergoing Percutaneous Endocardial and Epicardial Left Atrial Appendage Occlusion

Role of Imaging in Left Atrial Appendage Occlusion

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