Long‐term safety and efficacy of left atrial appendage closure in patients with small appendage orifices measured with transesophageal echocardiography

Wang, Binhao; Wang, Zhao; He, Bin; Fu, Guohua; Feng, Mingjun; Du, Xianfeng; Liu, Jing; Yu, Yi

doi:10.1002/clc.23950

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…A real-world analysis of >17,000 recipients of the Watchman implant reported the incidence of PE requiring intervention to be 1.2% (8). The rate of PE requiring intervention following Watchman implantation was 1.1% in our previously reported study (17). In the Amulet IDE trial, the incidence of PE was higher in patients receiving the Amulet occluder (2.4% vs. 1.2%) (6).…”

Section: Incidence Of Pe Following Laacmentioning

confidence: 68%

Pericardial effusion following percutaneous left atrial appendage closure using the LAmbre device

Chu

Wang

et al. 2023

Front. Cardiovasc. Med.

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BackgroundPericardial effusion (PE) is an uncommon but serious complication that occurs following percutaneous left atrial appendage closure (LAAC). There are few data regarding PE following implantation of the LAmbre device for LAAC.MethodsPatients with nonvalvular atrial fibrillation (AF) undergoing percutaneous LAAC using the LAmbre device at the Arrhythmia Center of Ningbo First Hospital from October 2017 to March 2021 were retrospectively reviewed (n = 133). PE was defined as acute if diagnosed ≤7 days post LAAC (n = 3, 2.3%) or delayed if diagnosed >7 days post LAAC (n = 3, 2.3%). The clinical characteristics and procedural data were compared between patients with PE (PE group, n = 6) and without PE (non-PE group, n = 127). The predictors of PE were analyzed by logistic regression.ResultsAll patients with PE recovered following treatment by pericardiocentesis. Patients with PE were found to have a higher incidence of congestive heart failure (50.0% vs. 13.4%, P = 0.044) and had larger measured LAA orifice diameters (33.5 mm ± 6.0 mm vs. 28.3 mm ± 5.2 mm, P = 0.018) and landing zone diameters (27.8 mm ± 4.8 mm vs. 23.9 mm ± 4.8 mm, P = 0.054) compared with those without PE. The diameters of the device umbrellas (31.7 mm ± 5.6 mm vs. 26.9 mm ± 5.0 mm, P = 0.026) and covers (36.3 mm ± 4.6 mm vs. 33.4 mm ± 4.0 mm, P = 0.075) implanted were larger in the PE group compared to the non-PE group. Univariate logistic regression revealed that congestive heart failure (OR = 6.47, 95% CI = 1.21–34.71, P = 0.029) and LAA maximal orifice diameter (OR = 1.22, 95% CI = 1.02–1.45, P = 0.027) were both associated with PE following LAmbre device implantation.ConclusionsIn this single-center experience, both acute and delayed PE were uncommon in patients with AF following LAmbre device implantation. Congestive heart failure and a larger LAA orifice were identified as predictors for the occurrence of PE.

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Section: Incidence Of Pe Following Laacmentioning

confidence: 68%

Pericardial effusion following percutaneous left atrial appendage closure using the LAmbre device

Chu

Wang

et al. 2023

Front. Cardiovasc. Med.

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“…Some cardiologists have advocated for fluoroscopy-guided LAAC without echocardiography guidance, which appears feasible and safe (20,21). In another study (22), to shorten the duration of TEE probe placement, TEE was performed at the end of the procedure to confirm the position and residual flow of the occluder device. As mentioned in our results, we believed that echocardiography was necessary to rule out the intraoperative thrombus and reduce the risk of perioperative stroke during the "one-stop" procedures.…”

Section: Discussionmentioning

confidence: 99%

Comparison of intracardiac vs. transesophageal echocardiography for “one-stop” procedures of combined radiofrequency catheter ablation and left atrial appendage closure with the Watchman device in the treatment of atrial fibrillation

Shang,

Sun,

Wang

et al. 2023

Front. Cardiovasc. Med.

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Background and objectiveThis study aimed to assess the efficacy and safety of “one-stop” procedures that combined radiofrequency catheter ablation and left atrial appendage closure (LAAC) with the Watchman device under the guidance of intracardiac echocardiography (ICE) vs. transesophageal echocardiography (TEE) in patients with atrial fibrillation.Methods and resultsIn this study, we prospectively enrolled patients who underwent “one-stop” procedures under the guidance of ICE (n = 193, 109 men, 65.02 ± 8.47 years) or TEE (n = 109, 69 men, 64.23 ± 7.75 years) between January 2021 and October 2022. Intraprocedural thrombus formation in the left atrial appendage (LAA) was observed in 3 (1.46%) patients in the ICE group and 15 (11.63%) patients in the TEE group (P < 0.05) before LAAC. Total fluoroscopy time and dose in the ICE group were less than those in the TEE group. The total “one-stop” turnaround time and LAAC procedure time in the ICE group were significantly shorter than those in the TEE group (P < 0.05). Postoperative esophagus discomfort, nausea and vomiting, and hypotension were more often seen in the TEE group (P < 0.001). There was no significant difference in matched cases between ICE and fluoroscopy measurements (P = 0.082). The TEE results related to LAAC and clinical events were similar between the two groups during the follow-up (P > 0.05).ConclusionThe ICE-guided “one-stop” procedure was safe and feasible with less radiation exposure, shorter turnaround time, and fewer complications and intraoperative thrombus formations than the TEE group. ICE offered accurate measurements in the LAA dimension during LAAC. Echocardiography during the “one-stop” procedures was necessary to rule out the intraoperative thrombus.

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Long‐term safety and efficacy of left atrial appendage closure in patients with small appendage orifices measured with transesophageal echocardiography

Wang

et al. 2022

Clinical Cardiology

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Background The Watchman device is the most widely used occluder but is indicated in atrial fibrillation (AF) patients with a maximal left atrial appendage (LAA) orifice diameter between 17 and 31 mm. We aimed to compare the long‐term safety and efficacy of left atrial appendage closure (LAAC) between patients with a small LAA (<17 mm) and those with an indicated LAA (17–31 mm) measured by transesophageal echocardiography (TEE). Methods A total of 369 AF patients treated with LAAC between March 2015 and February 2019 were included and divided into two groups based on the maximal LAA orifice diameter measured by TEE: small LAA group (n = 22) and indicated LAA group (n = 347). Periprocedural complications and long‐term clinical outcomes were compared. Results The Watchman device was successfully implanted in all patients. Mean device compression was higher in the small LAA group. Four patients (1.2%) in the indicated LAA group experienced pericardial effusion, and none experienced pericardial effusion in the small LAA group. Device‐related thrombus was detected in one (4.5%) patient in the small LAA group and five (1.4%) in the indicated LAA group (p = .310). After a mean follow‐up period of 4.1 ± 1.6 years, one patient in the small LAA group (4.5%; 1.1/100 person‐years) and four in the indicated LAA group (1.2%; 0.3/100 person‐years) suffered an ischemic stroke (p = .266). Conclusions The safety and efficacy of LAAC with the Watchman device were comparable between patients with small and indicated LAA orifice diameters measured by TEE.

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Long‐term safety and efficacy of left atrial appendage closure in patients with small appendage orifices measured with transesophageal echocardiography

Cited by 3 publications

References 32 publications

Pericardial effusion following percutaneous left atrial appendage closure using the LAmbre device

Pericardial effusion following percutaneous left atrial appendage closure using the LAmbre device

Comparison of intracardiac vs. transesophageal echocardiography for “one-stop” procedures of combined radiofrequency catheter ablation and left atrial appendage closure with the Watchman device in the treatment of atrial fibrillation

Long‐term safety and efficacy of left atrial appendage closure in patients with small appendage orifices measured with transesophageal echocardiography

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