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Background Approximately 90% of intracardial thrombi originate from the left atrial appendage in non-valvular atrial fbrillation patients. Even with anticoagulant therapy, left atrial appendage thrombus (LAAT) still occurs in 8% of patients. While left atrial appendage closure (LAAC) could be a promising alternative, the current consensus considers LAAT a contraindication to LAAC. However, the feasibility and safety of LAAC in patients with LAAT have yet to be determined. Methods This systematic review synthesizes published data to explore the feasibility and safety of LAAC for patients with LAAT. Results This study included a total of 136 patients with LAATs who underwent successful LAAC. The Amulet Amplatzer device was the most frequently utilized device (48.5%). Among these patients, 77 (56.6%) had absolute contraindications to anticoagulation therapy. Cerebral protection devices were utilized by 47 patients (34.6%). Transesophageal echocardiography (TEE) is the primary imaging technique used during the procedure. Warfarin and novel oral anticoagulants were the main anticoagulant medications used prior to the procedure, while dual antiplatelet therapy was primarily used post-procedure. During a mean follow-up period of 13.2±11.5 months, there was 1 case of fatality, 1 case of stroke, 3 major bleeding events, 3 instances of device-related thrombus, and 8 cases of peri-device leakage. Conclusions This review highlights the preliminary efectiveness and safety of the LAAC procedure in patients with persistent LAAT. Future large-scale RCTs with varied LAAT characteristics and LAAC device types are essential for evidence-based decision-making in clinical practice. [ABSTRACT FROM AUTHOR]

Background Obesity increases and surgical weight reduction decreases the risk of atrial fibrillation (AF) and heart failure (HF). We hypothesized that surgically induced weight loss may favorably affect left atrial (LA) mechanical function measured by longitudinal strain, which has recently emerged as an independent imaging biomarker of increased AF and HF risk. Methods We retrospectively evaluated echocardiograms performed before and 12.2±2.2 months after bariatric surgery in 65 patients with severe obesity (mean age 39 [36; 47] years, 72% of females) with no known cardiac disease or arrhythmia. The LA mechanical function was measured by the longitudinal strain using the semi-automatic speckle tracking method. Results After surgery, body mass index decreased from 43.72±4.34 to 30.04±4.33 kg/m2 . We observed a significant improvement in all components of the LA strain. LA reservoir strain (LASR) and LA conduit strain (LASCD) significantly increased (35.7% vs 38.95%, p=0.0005 and−19.6% vs−24.4%, p<0.0001) and LA contraction strain (LASCT) significantly decreased (−16% vs−14%, p=0.0075). There was a significant correlation between an increase in LASR and LASCD and the improvement in parameters of left ventricular diastolic and longitudinal systolic function (increase in E’ and MAPSE). Another significant correlation was identified between the decrease in LASCT and an improvement in LA function (decrease in A’). Conclusions The left atrial mechanical function improves after bariatric surgery. It is partially explained by the beneficial effect of weight reduction on the left ventricular diastolic and longitudinal systolic function. This effect may contribute to decreased risk of AF and HF after bariatric surgery. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess stroke risk and Cardio-cerebrovascular symptom knowledge in patients with atrial fibrillation, and to determine the relationship between knowledge and self-management in these patients. Methods: Using a cross-sectional study design, 120 patients from an outpatient clinic were recruited from two medical centers. Data were collected using a structured questionnaire, and data on risk factors and clinical characteristics were collected from patients' medical records. The data were analyzed by one-way analysis of variance, Pearson correlation coefficient, and hierarchical multiple linear regression analysis. Results: The risk of stroke was estimated to be 82.5%. For the assessment of patient cardio-cerebrovascular symptom knowledge the correct answer rate was as 37%. Hierarchical regression analysis showed that knowledge about cardio-cerebrovascular disease symptoms was a significant predictor, explaining an additional 28.3% of the variance of self-management behaviors. Conclusions: These results suggest the need for education programs that include information about cardiocerebrovascular disease symptoms and the risks of stroke occurring as a complication, in order to enhance self-management behaviors in patients with atrial fibrillation. [ABSTRACT FROM AUTHOR]

The article describes the case of a 41 year old female with a history of parxysmal atrial fibrillation and cavotricuspid isthmus (CTI)-dependent flutter who was returned to the electrophysiology laboratory for repeat ablation due to recurrent atrial fibrillation and flutter despite antiarryhythmic therapy. Topics discussed include the difficulty of distinguishing very slow conduction against CTI conduction block and the importance of performing multiple techniques to assess block.