Nonthrombogenic Roles of the Left Atrial Appendage

Alkhouli, Mohamad; Biase, Luigi Di; Rihal, Charanjit S.; Holmes, David R.; Asirvatham, Samuel J.; Bartuś, Krzysztof; Lakkireddy, Dhanunjaya; Friedman, Paul A.

doi:10.1016/j.jacc.2023.01.017

Cited by 13 publications

(3 citation statements)

References 59 publications

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“…In the etiology of cardioembolic stroke in patients suffering from AF, the LAA is a structure of particular interest. Although the LAA plays a role in homeostasis, hemodynamics, and arrhythmogenesis [52], it is mostly infamous for its role in thrombus formation. In their 1996 review, Blackshear and Odell reported that 91% of LA thrombi in patients with non-rheumatic AF originated in the LAA [53].…”

Section: The Left Atrial Appendage As the Cradle Of Thrombimentioning

confidence: 99%

Mechanisms and Prediction of Ischemic Stroke in Atrial Fibrillation Patients

Aarnink,

Zabern,

Boersma

et al. 2023

JCM

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Atrial fibrillation (AF) is the most common arrhythmia in adults worldwide and represents an important burden for patients, physicians, and healthcare systems. AF is associated with substantial mortality and morbidity, due to the disease itself and its specific complications, such as the increased risk of stroke and thromboembolic events associated with AF. The temporal relation between AF episodes and stroke is nonetheless incompletely understood. The factors associated with an increased thromboembolic risk remain unclear, as well as the stroke risk stratification. Therefore, in this review, we intend to expose the mechanisms and physiopathology leading to intracardiac thrombus formation and stroke in AF patients, together with the evidence supporting the causal hypothesis. We also expose the risk factors associated with increased risk of stroke, the current different risk stratification tools as well as future prospects for improving this risk stratification.

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Section: The Left Atrial Appendage As the Cradle Of Thrombimentioning

confidence: 99%

Mechanisms and Prediction of Ischemic Stroke in Atrial Fibrillation Patients

Aarnink,

Zabern,

Boersma

et al. 2023

JCM

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“…New important systemic functions of the left atrial appendage are now being described. The four major areas of influence have been defined by Alkhouli and coworkers: hormonal regulation, hemodynamics, atrial arrhythmia, and stem cell reservoir [30]. Neurohormonal regulation is related to changes in ANP and BNP secretion (which may be affected by epicardial occlusion of the left atrial appendage closure, as demonstrated in the HOMEOSTASIS study) [31] and, in addition, to the long-term regulation of aldosterone, epinephrine, norepinephrine, renin, and vasopressin, the levels of which were persistently and significantly reduced in patients undergoing left atrial appendage closure with the LARIAT device in the HOMEOSTASIS II study [32][33][34].…”

Section: Roles Of the Left Atrial Appendagementioning

confidence: 99%

LARIAT or AtriClip: Complications Profile and Comparison in Patients with Atrial Fibrillations Based on Manufacturer and User Facility Device Experience Database

Litwinowicz,

Batko,

Rusinek

et al. 2023

Medicina

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Background and Objectives: Left atrial appendage closure is an alternative treatment to reduce thromboembolism in patients with atrial fibrillation in whom oral anticoagulation (OAC) is contraindicated. The aim of this study was to evaluate the complications profiles of the LARIAT and AtriClip devices and perform a comparison between them based on the MAUDE (Manufacturer and User Facility Device Experience) database. Materials and Methods: The Manufacturer and User Facility Device Experience database was searched on 15 January 2023. For AtriClip, only reports regarding isolated procedures or procedures associated with minimally invasive ablation were included. Adverse effects and causes of death were defined based on the literature on the topic and the causes described in the reports. In total, 63 patients were included in the LARIAT group and 53 patients were included in the AtriClip group. Results: With the LARIAT device, the most common complication without device problems was pericardial effusion (n = 18, 52.9%), whereas this complication was not observed with AtriClip (p < 0.001). Postoperative bleeding was a second complication that occurred significantly more often in the LARIAT group—in 15 (44.1%) cases versus 1 (2.7%) case with AtriClip (p < 0.001). In addition, significant differences were found in the prevalence of stroke (LARIAT n = 0 vs. AtriClip n = 7, 18.9%, p = 0.012) and thrombus (LARIAT n = 2, 5.9% vs. n = 11, 29.7%, p = 0.013). Conclusions: Each type of left atrial appendage closure procedure is associated with device-specific requirements and complications that, if known, can be avoided.

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“…(3) Are there significant biochemical and/or endocrinologic effects after LAAO and will those changes affect clinical outcome [ 129 , 130 ]?…”

Section: Future Perspectivesmentioning

confidence: 99%

Percutaneous Left Atrial Appendage Occlusion Therapy: Evolution and Growing Evidence

Han¹,

Benditt²

2023

Rev. Cardiovasc. Med.

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Atrial fibrillation (AF) is the most common cardiac arrhythmia and if untreated, significantly increases both the risk of intracardiac thrombus formation and ischemic stroke. In patients with nonvalvular AF (NVAF), the left atrial appendage (LAA) has been estimated to be the source of thrombus development in 91% to 99% of cases. Consequently, oral anticoagulation (OAC) to provide stroke prevention has become the standard of care for most AF patients; however, OACs are associated with a risk of bleeding and their efficacy depends on optimal patient compliance. In terms of alternative approaches to preventing embolic events, surgical LAA excision was attempted as early as in the late 1940s in patients with valvular AF; LAA excision remains a recommendation in surgical guidelines for NVAF patients who need open-heart coronary bypass or valvular replacement/repair surgeries. However, due to its invasive nature surgical LAA intervention has limited clinical application in present cardiology practice. Percutaneous LAA occlusion (LAAO) is increasingly being performed as an alternative to OAC for stroke prevention; this is particularly the case in patients at increased bleeding risk. Substantial progress has been made in percutaneous LAAO therapy since its inception some twenty years ago. Herein we systematically review both the critical literature that led to the development of LAAO, and the increasing clinical evidence supporting the application of this treatment strategy in NVAF. To this end we focus on recently published critical evaluations of United States Food and Drug Administration (US FDA) and Conformité Européenne (Commercial Sale of Licensed Product in the EU) (CE-Mark) approved LAAO devices, summarize the current status of LAAO therapy, and discuss the future perspectives regarding the knowledge and technology gaps in this area by recognizing the potential contributions of many ongoing but likely transformative clinical trials.

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Nonthrombogenic Roles of the Left Atrial Appendage

Cited by 13 publications

References 59 publications

Mechanisms and Prediction of Ischemic Stroke in Atrial Fibrillation Patients

Mechanisms and Prediction of Ischemic Stroke in Atrial Fibrillation Patients

LARIAT or AtriClip: Complications Profile and Comparison in Patients with Atrial Fibrillations Based on Manufacturer and User Facility Device Experience Database

Percutaneous Left Atrial Appendage Occlusion Therapy: Evolution and Growing Evidence

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