Left atrial appendage occlusion for stroke prevention in diabetes mellitus patients with atrial fibrillation: Long‐term results

Litwinowicz, Radosław; Bartuś, Magdalena; Ceranowicz, Piotr; Brzeziński, Michał; Kapelak, Bogusław; Lakkireddy, Dhanunjaya; Bartuś, Krzysztof

doi:10.1111/1753-0407.12824

Cited by 23 publications

(27 citation statements)

References 42 publications

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“…Two randomized studies, PROTECT AF [8] and PROTECT AF CAP Registry [24], showed that LAAC is as effective in preventing stroke in patients with nonvalvular AF as warfarin treatment. Authors in previous studies also confirm that LAAC is safe and effective in AF patients [6,7,25] even in patients with higher thromboembolic risk such as those with diabetes [11] or increased age [12].…”

Section: Discussionmentioning

confidence: 74%

Left Atrial Appendage Occlusion for Secondary Stroke Prevention in Patients with Atrial Fibrillation: Long-Term Results

et al. 2019

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Background: Patients surviving an initial stroke present a significantly increased risk for further strokes. Left atrial appendage closure (LAAC) became an alternative treatment to pharmacological therapy for stroke prevention in atrial fibrillation (AF) patients. Objective: To evaluate the long-term efficacy of LAAC in primary and secondary stroke prevention in patients with AF. Methods: This retrospective study enrolled 139 patients following LAAC who were divided into 2 groups: 37 patients with prior stroke (Stroke Group) and 102 patients without stroke (Control Group). Overall, cumulative follow-up was 530.1 patient-years. Results: Mean CHADS2, CHA2DS2-VASc scores, and HAS-BLED score were higher in patients with prior stroke compared to patients without stroke (3.0 vs. 1.4, p < 0.0001 and 4.6 vs. 2.3, p < 0.0001, 4.0 vs. 2.8, p < 0.0001, respectively). There were no significant differences between other patient factors (sex, heart failure, hypertension, previous stroke/transient ischemic attack, peripheral vascular disease), which may increase the risk of thromboembolism based on the CHA2DS2-VASc score. Average follow-up was 51.3 months in patients with previous stroke and 50 months in patients without previous stroke. Thromboembolic event rate was 0.8 vs. 0.5 (p = 0.72), bleeding event rate was 0 years vs. 1.4 (p = 0.25), and mortality rates were 0.8 vs. 2.1 (p = 0.38) between the Stroke Group and the Control Group. The estimated reductions in thromboembolic and bleeding risks were 89 and 100%, respectively, in Stroke Group, and 91 and 81%, respectively, in Control Group. Conclusion: Patients with prior stroke may be the preferred group for LAAC regardless of the presence or absence of contraindications for anticoagulant therapy.

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Section: Discussionmentioning

confidence: 74%

Left Atrial Appendage Occlusion for Secondary Stroke Prevention in Patients with Atrial Fibrillation: Long-Term Results

et al. 2019

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“…Our procedure was performed via thoracoscopic access and therefore was less traumatic for the patient. Moreover, the use of an epicardial approach enables simultaneous performance of left atrial appendage occlusion with the LARIAT system to decrease the risk of stroke [6,7]. In the study by Coolbear et al [8] only 13% of patients were free of AF after nearly four years of observation following surgical RF ablation.…”

Section: Resultsmentioning

confidence: 99%

Recurrence of atrial fibrillation ten years after thoracoscopic transdiaphragmatic epicardial radiofrequency ablation

et al. 2018

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INTRODUCTION Atrial fibrillation (AF) is the most frequent cardiac arrhythmia [1]. According to the European Society of Cardiology, AF may affect up to 3% of adults aged 20 years or older [1]. It is also associated with high rates of mortality and morbidity [1, 2]. Over the last 30 years, the number of invasive rhythm control methods has significantly increased. Percutaneous approaches, due to their low level of invasiveness, short period of postprocedural recovery, and low rate of complications, have gained popularity. However, it has been shown that sinus rhythm is present in only 66% to 89% of patients after 12 months of follow-up, and that the procedure must be repeated in 10% to 25% of patients to achieve a satisfactory effect [2, 3]. An alternative method of treatment in cases of AF resistant to standard therapy is epicardial radiofrequency (RF) ablation. This method is safe for the patient but requires general anaesthesia and an experienced surgeon to perform the procedure. Our previous short-term observations showed that after one year, the rate of successful thoracoscopic transdiaphragmatic ablation remains at over 80% after a single procedure [2]. Herein we present our 10-year outcomes of thoracoscopic transdiaphragmatic epicardial RF ablation.

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“…Finally, our analysis was limited to endoluminal LAAO devices. Epicardial systems, such as the LARIAT system (SentreHEART Inc., Redwood City, CA, USA) were excluded from the study as the provided analyses were not applicable to epicardial systems …”

Section: Discussionmentioning

confidence: 99%

“…Epicardial systems, such as the LARIAT system (SentreHEART Inc., Redwood City, CA, USA) were excluded from the study as the provided analyses were not applicable to epicardial systems. 17,18 Although the study is subject to several limitations, it is a unique data set comparing different LAAO devices under largely standardized conditions and aims to increase the understanding of the mechanical behavior of these devices.…”

Section: Limitationsmentioning

confidence: 99%

Mechanical properties of currently available left atrial appendage occlusion devices: A bench‐testing analysis

et al. 2019

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Endoluminal left atrial appendage occlusion is an emerging therapy to treat patients suffering from atrial fibrillation with contraindications against oral anticoagulation. Different occlusion devices have been introduced into the clinical setting while comparative studies between the devices are sparse. This in vitro study compares several endoluminal left atrial appendage occlusion systems regarding 2 mechanical properties: radial (RF) and tug force (TF). Seven different occluder systems of various sizes (24 in total) underwent testing throughout their recommended sizing range. RF was measured in a commercial RF tester. TF was assessed according to a recently published bench test. RF increased with compression of the devices: The LAmbre 2228 device exerted the highest RF (8.6 N) at maximum compression of 16 mm. The lowest RF of 0.1 N was exhibited by the 27 mm Occlutech occluder at minimal compression. The highest TFs were exerted by the WaveCrest devices at maximum compression with 4.6 and 3.6 N for the 22 mm and the 27 mm device, respectively. The lowest TFs were measured for the first‐generation Occlutech devices, particularly for the 24 mm device with 1.1 N at maximum compression and 0.4 N at minimum compression. A strong positive correlation was found between the number of hooks per millimeter circumference of an occluder and its tug force (r = 0.87, P < 0.01). The analysis revealed device stability to be more dependent on anchoring structures than on RF. The wide range of mechanical properties makes comparison of current LAA occluders difficult and emphasizes the need for standardized preclinical testing to prompt clinical compatibility.

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Left atrial appendage occlusion for stroke prevention in diabetes mellitus patients with atrial fibrillation: Long‐term results

Abstract: The present study indicates that LAAO in AF patients with DM has similar safety endpoints and long-term efficacy as LAAO in patients without DM.

Cited by 23 publications

References 42 publications

Left Atrial Appendage Occlusion for Secondary Stroke Prevention in Patients with Atrial Fibrillation: Long-Term Results

Left Atrial Appendage Occlusion for Secondary Stroke Prevention in Patients with Atrial Fibrillation: Long-Term Results

Recurrence of atrial fibrillation ten years after thoracoscopic transdiaphragmatic epicardial radiofrequency ablation

Mechanical properties of currently available left atrial appendage occlusion devices: A bench‐testing analysis

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