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1. Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication

Author

Aarnink, Errol W., Maarse, Moniek, Fierro, Nicolai, Mazzone, Patrizio, Beneduce, Alessandro, Tondo, Claudio, Gasperetti, Alessio, Pracon, Radoslaw, Demkow, Marcin, Zieliński, Kamil, de Backer, Ole, Korsholm, Kasper, Nielsen-Kudsk, Jens Erik, Estévez-Loureiro, Rodrigo, Caneiro-Queija, Berenice, Benito-González, Tomás, Pérez de Prado, Armando, Nombela-Franco, Luis, Salinas, Pablo, Holmes, David, Almakadma, Abdul H., Berti, Sergio, Romeo, Maria Rita, Millan, Xavier, Arzamendi, Dabit, Alla, Venkata M., Agarwal, Himanshu, Eitel, Ingo, Paitazoglou, Christina, Freixa, Xavier, Cepas-Guillén, Pedro, Chothia, Rashaad, Badejoko, Solomon O., Spoon, Daniel B., Maddux, James T., El-Chami, Mikhael, Ram, Pradhum, Branca, Luca, Adamo, Marianna, Suradi, Hussam S., Peper, Joyce, van Dijk, Vincent F., Rensing, Benno J.W.M., Swaans, Martin J., Vireca, Elisa, Bergmann, Martin W., and Boersma, Lucas V.A.

Published
2024
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2. Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes

Author

Mesnier, Jules, Simard, Trevor, Jung, Richard G., Lehenbauer, Kyle R., Piayda, Kerstin, Pracon, Radoslaw, Jackson, Gregory G., Flores-Umanzor, Eduardo, Faroux, Laurent, Korsholm, Kasper, Chun, Julian K.R., Chen, Shaojie, Maarse, Moniek, Montrella, Kristi, Chaker, Zakeih, Spoon, Jocelyn N., Pastormerlo, Luigi E., Meincke, Felix, Sawant, Abhishek C., Moldovan, Carmen M., Qintar, Mohammed, Aktas, Mehmet K., Branca, Luca, Radinovic, Andrea, Ram, Pradhum, El-Zein, Rayan S., Flautt, Thomas, Ding, Wern Yew, Sayegh, Bassel, Benito-González, Tomás, Lee, Oh-Hyun, Badejoko, Solomon O., Paitazoglou, Christina, Karim, Nabeela, Zaghloul, Ahmed M., Agarwal, Himanshu, Kaplan, Rachel M., Alli, Oluseun, Ahmed, Aamir, Suradi, Hussam S., Knight, Bradley P., Alla, Venkata M., Panaich, Sidakpal S., Wong, Tom, Bergmann, Martin W., Chothia, Rashaad, Kim, Jung-Sun, Pérez de Prado, Armando, Bazaz, Raveen, Gupta, Dhiraj, Valderrábano, Miguel, Sanchez, Carlos E., El Chami, Mikhael F., Mazzone, Patrizio, Adamo, Marianna, Ling, Fred, Wang, Dee Dee, O’Neill, William, Wojakowski, Wojtek, Pershad, Ashish, Berti, Sergio, Spoon, Daniel B., Kawsara, Akram, Jabbour, George, Boersma, Lucas V.A., Schmidt, Boris, Nielsen-Kudsk, Jens Erik, Freixa, Xavier, Ellis, Christopher R., Fauchier, Laurent, Demkow, Marcin, Sievert, Horst, Main, Michael L., Hibbert, Benjamin, Holmes, David R., Jr., Alkhouli, Mohamad, and Rodés-Cabau, Josep

Published
2023
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3. Left Atrial Appendage Occlusion vs Standard of Care After Ischemic Stroke Despite Anticoagulation

Author

Maarse, Moniek, Seiffge, David J., Werring, David J., Boersma, Lucas V. A., Aarnink, Errol W., Fierro, Nicolai, Mazzone, Patrizio, Beneduce, Alessandro, Tondo, Claudio, Gasperetti, Alessio, Pracon, Radoslaw, Demkow, Marcin, Zielinski, Kamil, de Backer, Ole, Korsholm, Kasper, Nielsen-Kudsk, Jens Erik, Estévez-Loureiro, Rodrigo, Caneiro-Queija, Berenice, Benito-González, Tomás, de Prado, Armando Pérez, Nombela-Franco, Luis, Salinas, Pablo, Holmes, David, Almakadma, Abdul H., Berti, Sergio, Romeo, Maria Rita, Alvarez, Xavier Millan, Arzamendi, Dabit, Alla, Venkata M., Agarwal, Himanshu, Eitel, Ingo, Paitazoglou, Christina, Freixa, Xavier, Cepas-Guillén, Pedro, Chothia, Rashaad, Badejoko, Solomon O., Bergmann, Martin W., Spoon, Daniel B., Maddux, James T., El-Chami, Mikhael, Ram, Pradhum, Branca, Luca, Adamo, Marianna, Suradi, Hussam S., van Dijk, Vincent F., Rensing, Benno J. W. M., Zietz, Annaelle, Paciaroni, Maurizio, Caso, Valeria, Koga, Masatoshi, Toyoda, Kazunori, Kallmünzer, Bernd, Cappellari, Manuel, Wilson, Duncan, Engelter, Stefan, and Swaans, Martin J.

Abstract

IMPORTANCE: Patients with atrial fibrillation (AF) who have ischemic stroke despite taking oral anticoagulation therapy (OAT) have a very high risk of recurrence. Left atrial appendage occlusion (LAAO) is a mechanical stroke prevention strategy that may provide additional protection in patients with thromboembolic events under OAT. OBJECTIVE: To compare percutaneous LAAO with continuing OAT alone regarding stroke prevention in patients with AF who had a thromboembolic event despite taking OAT. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a propensity score–matched comparison of the STR-OAC LAAO cohort, an international collaboration of 21 sites combining patients from multiple prospective registries of patients who underwent LAAO between 2010 and 2022. STR-OAC LAAO cohort patients who had follow-up longer than 3 months were propensity score–matched to a previously published control cohort comprising patients from an established international collaboration of investigator-initiated prospective studies. This control cohort included patients with nonvalvular AF, recent ischemic stroke or transient ischemic attack, and follow-up longer than 3 months who were taking OAT before the index event. Analyses were adjusted for imbalances in gender, age, hypertension, diabetes, and CHA2 DS2-VASc score. EXPOSURE: Left atrial appendage occlusion vs continuation of oral anticoagulation therapy alone (control group). MAIN OUTCOMES AND MEASURES: The primary outcome was time to first ischemic stroke. RESULTS: Four hundred thirty-three patients from the STR-OAC LAAO cohort (mean [SD] age, 72 [9] years; 171 [39%] females and 262 [61%] males; mean [SD] CHA2 DS2-VASc score, 5.0 [1.6]) were matched to 433 of 1140 patients (38%) from the control group. During 2-year follow-up, 50 patients experienced ischemic stroke: an annualized event rate of 2.8% per patient-year in the STR-OAC LAAO group vs 8.9% per patient-year in the control group. Left atrial appendage occlusion was associated with a lower risk of ischemic stroke (hazard ratio, 0.33; 95% CI, 0.19-0.58; P < .001) compared with the control group. After LAAO, OAT was discontinued in 290 patients (67%), and the remaining 143 patients (33%) continued OAT after LAAO as an adjunctive therapy. CONCLUSIONS AND RELEVANCE: In patients with nonvalvular AF and a prior thromboembolic event despite taking OAT, LAAO was associated with a lower risk of ischemic stroke compared with continued OAT alone. Randomized clinical trial data are needed to confirm that LAAO may be a promising treatment option for this population with a very high risk of stroke.

Published
2024
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4. PO-03-135 LEFT ATRIAL APPENDAGE OCCLUSION VERSUS STANDARD OF CARE IN PATIENTS WITH ATRIAL FIBRILLATION AND A PRIOR THROMBO-EMBOLIC EVENT DESPITE ORAL ANTICOAGULANT THERAPY: A PROPENSITY SCORE MATCHED COMPARISON

Author

Maarse, Moniek, primary, Seiffge, David, additional, Aarnink, Errol, additional, Fierro, Nicolai, additional, Mazzone, Patrizio, additional, Beneduce, Alessandro, additional, Gasperetti, Alessio, additional, Tondo, Claudio, additional, Pracon, Radek, additional, Demkow, Marcin, additional, Zielinski, Kamil, additional, de Backer, Ole, additional, Korsholm, Kasper, additional, Nielsen-Kudsk, Jens Erik, additional, Estevez-Loureiro, Rodrigo, additional, Benito-Gonzalez, Tomas, additional, Nombela-Franco, Luis, additional, Simard, Trevor, additional, Alkhouli, Mohamad, additional, Holmes, David R., additional, Romeo, Maria Rita, additional, Berti, Sergio, additional, Millan, Xavier, additional, Arzamendi, Dabit, additional, Alla, Venkata M., additional, Paitazoglou, Christina, additional, Eitel, Ingo, additional, Freixa-Rofastes, Xavier, additional, Badejoko, Solomon, additional, Chothia, Rashaad A., additional, Kilic, Özlem, additional, Bergmann, Martin, additional, Spoon, Daniel, additional, Ram, Pradhum, additional, El-Chami, Mikhael F., additional, Branca, Luca, additional, Adamo, Marianna, additional, Danley, Kelsey, additional, Suradi, Hussam, additional, Swaans, Martin, additional, Werring, David, additional, and Boersma, Lucas V., additional

Published
2023
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6. Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

Author

Fauchier, Grégoire, Bisson, Arnaud, Bodin, Alexandre, Herbert, Julien, Semaan, Carl, Angoulvant, Denis, Ducluzeau, Pierre Henri, Lip, Gregory, Fauchier, Laurent, Deharo, Pierre, Cuisset, Thomas, Lacour, Thibaud, Etienne, Christophe Saint, Jaussaud, Nicolas, Morera, Pierre, Spychaj, Jean-Charles, Porto, Alizée, Collart, Frederic, Theron, Alexis, Bernard, Anne, Bourguignon, Thierry, Simard, Trevor, Jung, Richard, Lehenbauer, Kyle, Piayda, Kerstin, Pracoń, Radoslaw, Jackson, Gregory, Flores-Umanzor, Eduardo, Faroux, Laurent, Korsholm, Kasper, Chun, Julian K.R., Chen, Shaojie, Maarse, Moniek, Montrella, Kristi, Chaker, Zakeih, Spoon, Jocelyn, Pastormerlo, Luigi, Meincke, Felix, Sawant, Abhishek, Moldovan, Carmen, Qintar, Mohammed, Aktas, Mehmet, Branca, Luca, Radinovic, Andrea, Ram, Pradhum, El-Zein, Rayan, Flautt, Thomas, Ding, Wern Yew, Sayegh, Bassel, Benito-González, Tomás, Lee, Oh-Hyun, Badejoko, Solomon, Paitazoglou, Christina, Karim, Nabeela, Zaghloul, Ahmed, Agrawal, Himanshu, Kaplan, Rachel, Alli, Oluseun, Ahmed, Aamir, Suradi, Hussam, Knight, Bradley, Alla, Venkata, Panaich, Sidakpal, Wong, Tom, Bergmann, Martin, Chothia, Rashaad, Kim, Jung-Sun, Pérez de Prado, Armando, Bazaz, Raveen, Gupta, Dhiraj, Valderrabano, Miguel, Sanchez, Carlos, El Chami, Mikhael, Mazzone, Patrizio, Adamo, Marianna, Ling, Fred, Wang, Dee Dee, O’neill, William, Wojakowski, Wojtek, Pershad, Ashish, Berti, Sergio, Spoon, Daniel, Kawsara, Akram, Jabbour, George, Boersma, Lucas V.A., Schmidt, Boris, Nielsen-Kudsk, Jens Erik, Rodés-Cabau, Josep, Freixa, Xavier, Ellis, Christopher, Demkow, Marcin, Sievert, Horst, Main, Michael, Hibbert, Benjamin, Holmes, David, Alkhouli, Mohamad, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Trousseau [Tours], Éducation Éthique Santé EA 7505 (EES), Université de Tours (UT), EA4245 - Transplantation, Immunologie, Inflammation [Tours] (T2i), University of Liverpool, Aalborg University [Denmark] (AAU), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital de la Timone [CHU - APHM] (TIMONE), Nutrition, obésité et risque thrombotique (NORT), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Marseille, Département de Cardiologie [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Institut de neurophysiopathologie (INP), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), University of Ottawa [Ottawa], Université Laval [Québec] (ULaval), National Institute for Research and Development in Microtechnologies (IMT-Bucharest), Graduate School, Cardiology, and ACS - Heart failure & arrhythmias

Subjects
Male, Cardiac Catheterization, Time Factors, Percutaneous, left atrial appendage occlusion, Septal Occluder Device, medicine.medical_treatment, Transesophageal, [SHS]Humanities and Social Sciences, Pulmonary vein, Postoperative Complications, Risk Factors, Interquartile range, Atrial Fibrillation, Registries, Embolization, ComputingMilieux_MISCELLANEOUS, Watchman, Incidence, Atrial fibrillation, Europe, Survival Rate, Treatment Outcome, Echocardiography, Cardiology, Female, Watchman FLX, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Heart Diseases, ACP, Amplatzer cardiac plug, Amulet, DRT, LAAO, device-related thrombus, Aged, Atrial Appendage, Echocardiography, Transesophageal, Follow-Up Studies, Humans, Thrombosis, Left atrial appendage occlusion, Internal medicine, medicine, Risk factor, Thrombus, business.industry, medicine.disease, business
Abstract

Background: Device-related thrombus (DRT) has been considered an Achilles’ heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. Objectives: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. Methods: Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. Results: A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. Conclusions: DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.

Published
2021
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9. Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

Author

Simard, Trevor, primary, Jung, Richard G., additional, Lehenbauer, Kyle, additional, Piayda, Kerstin, additional, Pracoń, Radoslaw, additional, Jackson, Gregory G., additional, Flores-Umanzor, Eduardo, additional, Faroux, Laurent, additional, Korsholm, Kasper, additional, Chun, Julian K.R., additional, Chen, Shaojie, additional, Maarse, Moniek, additional, Montrella, Kristi, additional, Chaker, Zakeih, additional, Spoon, Jocelyn N., additional, Pastormerlo, Luigi E., additional, Meincke, Felix, additional, Sawant, Abhishek C., additional, Moldovan, Carmen M., additional, Qintar, Mohammed, additional, Aktas, Mehmet K., additional, Branca, Luca, additional, Radinovic, Andrea, additional, Ram, Pradhum, additional, El-Zein, Rayan S., additional, Flautt, Thomas, additional, Ding, Wern Yew, additional, Sayegh, Bassel, additional, Benito-González, Tomás, additional, Lee, Oh-Hyun, additional, Badejoko, Solomon O., additional, Paitazoglou, Christina, additional, Karim, Nabeela, additional, Zaghloul, Ahmed M., additional, Agrawal, Himanshu, additional, Kaplan, Rachel M., additional, Alli, Oluseun, additional, Ahmed, Aamir, additional, Suradi, Hussam S., additional, Knight, Bradley P., additional, Alla, Venkata M., additional, Panaich, Sidakpal S., additional, Wong, Tom, additional, Bergmann, Martin W., additional, Chothia, Rashaad, additional, Kim, Jung-Sun, additional, Pérez de Prado, Armando, additional, Bazaz, Raveen, additional, Gupta, Dhiraj, additional, Valderrabano, Miguel, additional, Sanchez, Carlos E., additional, El Chami, Mikhael F., additional, Mazzone, Patrizio, additional, Adamo, Marianna, additional, Ling, Fred, additional, Wang, Dee Dee, additional, O’Neill, William, additional, Wojakowski, Wojtek, additional, Pershad, Ashish, additional, Berti, Sergio, additional, Spoon, Daniel, additional, Kawsara, Akram, additional, Jabbour, George, additional, Boersma, Lucas V.A., additional, Schmidt, Boris, additional, Nielsen-Kudsk, Jens Erik, additional, Rodés-Cabau, Josep, additional, Freixa, Xavier, additional, Ellis, Christopher R., additional, Fauchier, Laurent, additional, Demkow, Marcin, additional, Sievert, Horst, additional, Main, Michael L., additional, Hibbert, Benjamin, additional, Holmes, David R., additional, and Alkhouli, Mohamad, additional

Published
2021
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