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Objective To observe the incidence of pericardial tamponade(PT)after left atrial appendage closure(LAAC)in patients with non-valvular atrial fibrillation(NVAF),and to explore its related factors and outcomes.Methods NVAF patients who were hospitalized and treated with LAAC in Department of Cardiology of our hospital from August 2014 to March 2023 were selected for the study.The general clinical data,preoperative transthoracic echocardiography and transesophageal echocardiography data,results of routine preoperative laboratory tests,intraoperative data and follow-up data of the patients were collected through the hospital medical record management system.The enrolled patients were classified into the non-PT group(n=8)and the PT group(n =1184)according to whether PT occurred after LAAC or not.The incidence of PT,related risk factors and outcomes were statistically analyzed.Results This study included 639 males(53.6%)and 553 females(46.4%),with an average age of 68.1±9.65 years.The CHA2 DS2-VASc score was 4.51±1.72,and the HAS-BLED score was 3.36±1.09.PT occurred in 8 cases(0.67%),among them,6 cases occurred 1 to 33 h after LAAC,and 2 cases occurred on day 19 and day 27 after LAAC.As for the results of transesophageal echocardiography(TEE)and LAA angiography,compared with the non-PT group,the PT group had the significantly larger maximum caliber of the LAA(P=0.025,P=0.015),smaller maximum depth of the LAA(P=0.028,P=0.031),and lower success rate of one-time placement of the occluder(P=0.031);The occluder compression rate of the PT group was significantly greater than that of the non-PT group(P=0.046).Multivariate analysis showed that larger maximum diameter of LAA,smaller average effective depth of LAA and larger compression rate of occluder were the main risk factors for PT.All the 8 PT patients were cured by stopping antithrombotic drugs,pericardiocentesis or surgical drainage.During a mean follow-up of 39±27 months,there were no device-related thrombosis(DRT),ischemic stroke,systemic embolism and other complications in the PT group.Conclusion The incidence of PT after LAAC is low,which is related to the large diameter of LAA,the relatively insufficient depth of the LAA and the large compression rate of the occlude.PT can be cured by stopping antithrombotic drugs and pericardiocentesis/surgical drainage.
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Objective:To explore the effects of the LAmbre device and mitral annulus(MA), as well as left atrium(LA) in patients with non-valvular atrial fibrillation(NVAF) after left atrial appendage closure (LAAC) using real-time-three-dimensional transesophageal echocardiography (3D TEE).Methods:Fity-six consecutive patients who underwent LAAC with the LAmbre device in Zhongshan Hospital of Fudan University from June 2019 to March 2023 were retrospectively enrolled, with no or less than moderate mitral regurgitation (MR). All patients underwent pre-operative and follow-up two-and three-dimensional transesophageal echocardiography (2D TEE, 3D TEE) at 60 days after the operation. The quantitative parameters of MA and LA were obtained by offline analysis using QLab 13.0 (Philips Healthcare, Andover, MA). Importantly, mitral annular measurements were made at seven time points throughout the cardiac cycle: early diastole, mid-diastole, late diastole, mitral valve closure, early systole, mid-systole, and late systole, which facilitates constructing the dynamic model of MA to assess the annular morphology and dynamics.Results:The values of AP diameter (APD), AL-PM diameter (ALPMD), 3D annulus circumference (3DAC), 3D annulus area (3DAA) decreased significantly compared with pre-operative values at all time points of the cardiac cycle (all P<0.05), while non-planar angle (NPA) and AH/CD were not apparently changed (all P>0.05 ). Throughout the cardiac cycle, MA showed regular changes, gradually increased in systole with the saddle shape deepened, and gradually decreased in diastole with the saddle shape shallowed.During systole, there was an increase in the rate of change of AP in MA [pre-operative (3.01±2.64)%, post-operative (3.81±3.51)%, P=0.037] after LAAC, with no significant difference in the rate of change of ALPM, 3DAC, and 3DAA.Meanwhile, we observed an evident reduction in LA minimal volume (LAVmin) [pre-operative (78.36±25.16)ml, post-operative (70.73±22.78)ml, P=0.004] and an obvious increase in LA ejection function [pre-operative (22.88±10.09)%, post-operative (31.41±12.28)%, P<0.05] during follow-up. Conclusions:3D TEE can accurately assess the impact of LAAC on the MA and LA. The LAmbre device can affect the morphology of MA, as well as the structure and function of LA, while the change of the dynamics of MA is not so prominent.
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Objective To investigate the incidence and influencing factors of right-to-left shunt(RLS)in patients with iatrogenic atrial septal defect(iASD)after atrial septal puncture during in-terventional therapy for atrial fibrillation and analyze the correlation with new onset migraine in order to provide a basis for the prevention and treatment of related clinical events.Methods A to-tal of 54 patients with atrial fibrillation who underwent interventional surgery[including radio-frequency catheter ablation(RFCA),left atrial appendage closure(LAAC),and'one-stop'sur-gery]in cardiologic department of our hospital from November 2022 to March 2023 were enrolled in this study.According to existence of RLS in iASD within 48 h after surgery,they were divided into RLS group(24 patients)and non-RLS group(30 patients).The general information and tran-sthoracic echocardiographic data were collected and analyzed for the occurrence and influencing factors of RLS.The incidence of new onset migraine within 3 months after operation was recorded in both groups.Results All these patients had left-to-right shunt of iASD,24 patients had RLS(44.44％),and the defect size was 5.12±0.80 mm.During the 3 months'follow-up period,there was no significant difference in the incidence of new onset migraine between the two groups(P＞0.05).Older age,increased proportion of persistent atrial fibrillation,and larger iASD size was seen in the RLS group than the non-RLS group(P＜0.05,P＜0.01).Multivariate logistic regres-sion analysis showed that iASD size was a risk factor for RLS(OR=2.245,95％CI:1.040-4.846,P=0.040).Conclusion RLS is common in iASD after interventional treatment of atrial fibrillation,which is not related to the early occurrence of new onset migraine in these patients.The size of iASD is a risk factor for RLS.At the same time,more attention should be paid to the influence of iASD on hemodynamics and clinical events.
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Introduction: In hospitalized patients, atrial fibrillation is the most common arrhythmia, and leading cause of cardio-embolic stroke. Objective: To evaluate the association between N-terminal b-type natriuretic peptide pro (NT-proBNP) and left atrial appendage thrombus in persistent atrial fibrillation patients. Methods: A cross-sectional study, enrolled 139 patients with persistent non-valvular atrial fibrillation. Transthoracic and trans-esophageal echocardiographs were performed in all patients. Results: Mean age was 70.5 ( 10.6 years, 80.6% male. In patients with LAAT, NT-proBNP was positively correlated with left ventricular end diastolic diameter (LVEDD) (r=0.345), left ventricular end-systolic diameter (LVEDS) (r= 0.449), E/e' (r=0.445), and left atrial spontaneous echo contrast (LA SEC) (r=0.478), and negatively correlated with left ventricular ejection fraction (LVEF) (r=-0.473), left atrial strain (r= -0.301), strain rate (r= -0.283), and e'(r= -0.458). In patients without LAAT, NT-proBNP was positively correlated with LVEDD (r= 0.333), LVESD (r= 0.358), E (r= 0.318), E/e' (r= 0.411), left atrial volume index (LAVI) (r= 0.421), and negatively correlated with LVEF (r= -0.307). Plasma NT-proBNP (> 1279 pg/mL) could be used to predict LAAT (AUC= 0.639; Se= 67.7 percent, Sp= 60.2 percent). In patients with ejection fraction > 50 percent, the cutoff value of NT-proBNP to predict LAAT was 1325 pg/mL (AUC= 0.572; Se= 57.9 percent , Sp= 78.3 percent). Multiple logistic regression analysis showed that prior stroke, E/e' index, and NT-proBNP correlated with LAAT (r= 0.887; p< 0.001; r= -0.092, p= 0.035 and 0.022; p= 0.004, respectively). Conclusion: Plasma NT-proBNP levels and E/e' index are associated with LAAT in patients with persistent atrial fibrillation(AU)
Introducción: En pacientes hospitalizados, la fibrilación auricular es la arritmia más común y causa principal de ictus cardioembólico. Objetivo: Evaluar la asociación entre el péptido natriurético NT proBNP y el trombo en la orejuela auricular izquierda en pacientes con fibrilación auricular persistente. Métodos: Se reclutaron prospectivamente 139 pacientes con fibrilación auricular no valvular persistente. Se realizaron ecocardiografías transtorácicas y transesofágicas en todos los pacientes. Resultados: Edad media, 70,5±10,6 años; 80,6 por ciento hombres. En pacientes con LAAT, NT-proBNP correlacionó positivamente con el diámetro telediastólico del ventrículo izquierdo (DDVI) (r=0,345), diámetro sistólico final del ventrículo izquierdo (DSVI) (r=0,449), E/e' (r=0,445) y contraste de eco espontáneo auricular izquierdo (LA SEC) (r=0,478), y negativamente con la fracción de eyección del ventrículo izquierdo (FEVI) (r=-0,473), tensión auricular izquierda (r=-0,301), tasa de tensión (r=0,283) y e' (r=-0,458). En pacientes sin LAAT, NT-proBNP correlacionó positivamente con LVEDD (r= 0,333), LVESD (r=0,358), E (r=0,318), E/e' (r=0,411), índice de volumen auricular izquierdo (LAVI) (r=0,421), y negativamente con FEVI (r=-0,307). NT-proBNP plasmático (>1279 pg/mL) podría usarse para predecir LAAT (AUC=0,639; Se=67,7 por ciento, Sp=60,2 por ciento). En pacientes con fracción de eyección >50 por ciento; valor de corte de NT-proBNP para predecir LAAT fue 1325 pg/mL (AUC=0,572; Se=57,9 por ciento, Sp=78,3 por ciento). Según regresión logística múltiple, el accidente cerebrovascular previo, el índice E/e' y NT-proBNP se correlacionaron con LAAT (r=0,887; p<0,001; r=0,092, p=0,035 y 0,022; p=0,004, respectivamente). Conclusiones: Los niveles plasmáticos de NT-proBNP y el índice E/e' se asocian con el OAI en pacientes con FA persistente(AU)
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Context: Complex left atrial appendage (LAA) morphology is increasingly associated with cryptogenic ischemic stroke as compared to cardioembolic stroke due to atrial fibrillation (AF). However, data on such an association in patients with other etiological stroke subtypes in the absence of AF is limited. Aim: The study aimed to assess the LAA morphology, dimension and other echocardiographic parameters by transesophageal echocardiography (TEE) in patients with embolic stroke of undetermined source (ESUS) and compare it with other etiological stroke subtypes without known AF. Methods: This was a single-Centre, observational study involving comparison of echocardiographic parameters including LAA morphology and dimension in ESUS patients (group A; n ¼ 30) with other etiological stroke subtypes i.e., TOAST (Trial of Org 10172 in Acute Stroke Treatment) class I-IV without AF (group B; n ¼ 30). Results: Complex LAA morphology was predominant in group A (18 patients in group A versus 5 patients in group B, p-Value ¼ 0.001). Mean LAA orifice diameter (15.3 þ 3.5 mm in group A versus 17 þ 2.0 mm in group B, p-Value ¼ 0.027) and LAA depth were significantly lower in group A (28.4 þ 6.6 mm in group A versus 31.7 þ 4.3 mm in group B, p-Value ¼ 0.026). Out of these three parameters only complex LAA morphology was found to be independently associated with ESUS [OR ¼ 6.003, 95% CI {1.225e29.417}, p ¼ 0.027]. Conclusion: Complex LAA morphology is a predominant feature in ischemic stroke patients with ESUS and may contribute to an increased risk of stroke in these patients.
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Objective:To assess the safety and efficiency of left atrial appendage closure (LAAC) combined delayed anticoagulant therapy in atrial fibrillation (AF) patients combined with cardiogenic stroke during anticoagulant therapy.Methods:Using prospective research methods, 35 AF patients combined with cardiogenic stroke during anticoagulant therapy from September 2020 to June 2022 in Xuanwu Hospital, Capital Medical University were selected. All patients were treated with LAAC and delayed anticoagulant therapy. The endpoints were the safety and efficacy of LAAC combined with delayed anticoagulant therapy. The primary endpoint of efficacy was the composite endpoint of postoperative death, myocardial infarction, hemorrhagic stroke and systemic embolism. The safety endpoint was major bleeding as defined by the International Society for Thrombosis and Hemostasis and clinically relevant non-major bleeding.Results:Among 35 patients, 21 were males and 14 were females; the age was (68.5 ± 9.3) years old; the CHA 2DS 2-VASc score was 5 (4, 6) scores; the time to the last stroke was 95 (42, 98) d; the National Institutes of Health stroke scale score at the time of stroke was 3 (1, 6) scores. All patients successfully completed LAAC without perioperative instrument-surface thrombosis, death, new stroke or bleeding events. Thirty-two patients continued oral anticoagulant therapy 45 d after LAAC. The patients were followed up for (12.6 ± 4.3) months, 1 patient experienced recurrent ischemic stroke, 2 patients endured mucosal bleeding, there were no adverse events such as all-cause death, cardiovascular death, systemic embolism and hemorrhagic stroke. Conclusions:The LAAC combined delayed anticoagulant therapy is efficient and safe in patients with AF. For AF patients combined with cardiogenic stroke during anticoagulant therapy, LAAC combined with delayed anticoagulation therapy may be considered to further prevent ischemic stroke events.
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Objective This study aims to analyze the clinical and imaging characteristics of atrial fibrillation(AF)patients with left atrial appendage(LAA)hypoplasia and to explore the effectiveness of anticoagulation in preventing left atrial thrombus.Methods A retrospective analysis was conducted on five AF patients with LAA hypoplasia.The patients in this study were diagnosed using left atrial computed tomography venography venography(CTV)and/or transesophageal echocardiography(TEE)out of a total of 3 068 patients who were admitted to Zhoupu hospital between July 2018 and October 2023.The analysis included an examination of clinical features,and imaging data,and anticoagulation treatment was analyzed.Results The study found that out of the 5 patients with LAA hypoplasia,only one patient underwent both left atrial CTV and TEE examinations.One patient underwent chest CT scan and TEE,while the remaining three patients underwent complete left atrial CTV and were all diagnosed with LAA hypoplasia.The diagnosis relied on the delay and venous phase of multiplanar reconstruction of left atrial CTV,while TEE was only able to detect small crevices or no abnormalities.The incidence of LAA hypoplasia was 1.63‰.The characteristics of LAA hypoplasia include a small LAA,thick LAA wall,and LAA without cavity or small.All five AF patients were complicated with cardio-cerebrovascular atherosclerosis,one patient underwent cryoablation,and and antiplatelet or anticoagulant regimen or both therapy strategy was selected.Conclusions LAA hypoplasia is a unique subtype of LAA,that can be diagnosed through multi-plane reconstruction in the delayed and venous phase of left atrial CTV.TEE can serve as a supplementary diagnostic tool,and further research is needed to determine the anticoagulation regimen for AF patients with LAA hypoplasia.
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Objective To systematically evaluate the differences in preoperative planning for left atrial appendage closure(LAAC)using cardiac CT angiography(CCTA)and transesophageal echocardiography(TEE).Methods Relevant studies comparing CCTA and TEE for preoperative assessment of LAAC published from the inception of each database to July 18,2023,were searched in PubMed,EMBASE,the Cochrane Library,CNKI,Wanfang,and CBM database.Meta-analysis was performed using RevMan 5.4 and Stata 15.1.Results A total of 21 studies with 2 137 patients were included.Compared to TEE,preoperative CCTA measurement of the left atrial appendage(LAA)showed a larger maximum diameter(MD 2.27 mm,95％CI 1.70-2.83,P＜0.001)and higher accuracy in predicting occlusion device(RR 1.67,95％CI 1.39-2.01,P＜0.001).Subgroup analysis based on whether 3D reconstruction was performed and occlusion device type showed similar results.There was no statistically significant difference in the surgical success rate(RR 1.03,95％CI 0.98-1.08,P=0.230)between the two imaging methods.Additionally,preoperative 3D reconstruction based on CCTA resulted in fewer occlusion devices used(MID-0.29,95％CI-0.53--0.04,P=0.020),less contrast agent usage(MD-4.48 ml,95％CI-7.40—-1.56,P=0.003),shorter operative time(MD-14.98 min,95％CI-17.79—-12.17,P＜0.001),and a lower rate of postoperative residual leakage(RR 0.59,95％CI 0.36-0.99,P=0.040).Conclusions Compared to TEE,preoperative CCTA for LAAC improves the accuracy of occlusion device prediction.3D reconstruction based on CCTA reduces the occlusion devices used and the usage of contrast agents,shortens the operative time,improves surgical efficiency,and is associated with a lower rate of postoperative residual leakage.Therefore,CCTA has more advantages in preoperative planning for LAAC.
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Objective:To observe the occurrence and closure of iatrogenic atrial septal defect (IASD) after left atrial appendage occlusion (LAAo) and atrial fibrillation cryoballoon ablation (CBA), and to identify potential factors that may affect the occurrence of IASD.Methods:A total of 383 patients who underwent successful LAAo surgery in the Department of Cardiology at the Nanjing Hospital Affiliated to Nanjing Medical University from June 7, 2016 to December 2, 2020, and atrial fibrillation CBA surgery from December 29, 2016 to September 10, 2020 were retrospectively selected. Patients were followed up with echocardiography at 1 month, 3 months, 6 months, 1 year, and>1 year after surgery to determine the occurrence of IASD. The incidence of IASD between the two groups was compared, and clinical data between the two groups with and without IASD were analyzed to identify the relevant factors for the occurrence of IASD.Results:One month after CBA surgery for atrial fibrillation [73.8%(138/187) vs 47.9%(67/140), P<0.001], 3 months [39.0%(57/146) vs 13.6%(16/118), P<0.001], 6 months [17.7%(22/124) vs 3.6%(4/110), P=0.001], 1 year [11.8%(15/127) vs 1.8%(2/112), P=0.003], and one year later [9.8%(13/133) vs 0.9%(1/116), P=0.002], the incidence of IASD was significantly higher than those in LAAo. Compared with the non IASD group, the IASD group had a lower proportion of males [59.0%(121/205) vs 83.6%(102/122), P<0.001], and a higher proportion of paroxysmal atrial fibrillation [61.5%(126/205) vs 45.9%(56/122), P=0.006]. Logistic regression analysis found a significant correlation between women and CBA with postoperative IASD. Conclusions:Compared with LAAo, the incidence of IASD after CBA for atrial fibrillation is higher, and some IASD persist for more than 1 year after surgery. Women are significantly associated with IASD.
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@#Surgical treatment of atrial septal defect (ASD) mainly includes occlusion or repair under cardiopulmonary bypass. Surgical treatment of atrial fibrillation includes transcatheter radiofrequency ablation or Maze surgery under cardiopulmonary bypass. There are many treatments for ASD patients combined with atrial fibrillation, but each has its own advantages and disadvantages. We reported an ASD patient combined with atrial fibrillation treated by totally endoscopic "one-stop" radiofrequency ablation and simultaneous transthoracic ASD occlusion of atrial fibrillation, with good postoperative results.
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A 4?year?old child with supramitralmembrane (SMM) causing severemitral stenosis (MS) was taken for excision of themembrane. Intraoperative transesophageal echocardiography showed a large thrombus in the left atrial appendage (LAA) in addition to SMM.The case underscores the importance of this extremely rare association and prompt therapy to prevent catastrophic consequences.
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Background: Mitral stenosis (MS) is a common valvular heart disease. Thromboembolism is one of the most serious consequences of mitral stenosis, particularly when it is accompanied with atrial fibrillation (AF). When linked with Left atrial appendage inactivity (LAAI), patients with sinus rhythm (SR) are also at risk for this condition. In mitral stenosis, LAA inactivity determined by S-wave is an independent predictor of thromboembolism. The aim of the study was to evaluate the Prevalence and Echocardiographic Predictors of Left Atrial Appendage inactivity in patients of Mitral Stenosis.Material & Methods:Sixty MS patients were evaluated by transthoracic echocardiography (TTE) and all patients underwent transesophageal echocardiography (TEE). The annular systolic (S-wave) and diastolic (Em- and Am-waves) velocities were recorded by tissue Doppler imaging (TDI). LAA inactivity was defined as LAA emptying velocity <25 cm/second determined by pulse wave Doppler at the junction of LA & LAA (TEE). Patients were divided into three groups; group A I (n = 18). Sinus rhythm (SR) and LAA emptying velocity ?25 cm/sec, group A II (n -22): SR and LAA emptying velocity <25cm/sec and group B (n = 20): atrial fibrillation.Results:Thrombus was detected in 14 patients and spontaneous echo contrast (SEC) was detected in 43 patients. Both S-wave and peak LAA emptying velocities were decreasing, while SEC frequency and density were increasing from group A to group B. There was a positive correlation between LAA emptying vs. S-wave and LAA emptying vs. Am velocities (p < 0.001, r= 0.708 and p<0.001, r=0.495). Multivariate regression analysis showed that only S-wave is the independent predictor of inactive LAA (p = 0.001, odds ratio = 0.133, 95% Cl =0.032-0.556). In patients with SR, the cutoff value of S-wave was 10 cm/sec for the prediction of the presence of inactive LAA (sensitivity: 92.3%, specificity: 95.3%).Conclusions:In individuals with severe mitral stenosis in sinus rhythm, there is a significant prevalence of left atrial appendage inactivity. The mean pressure gradient across the mitral valve, as well as S-wave are independent predictors of left atrial appendage inactivity. Inactivity of the left atrial appendage is an independent predictor of left atrial/left atrial appendage smoke and associated thrombus.
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Resumen La fibrilación auricular es la arritmia más prevalente en la práctica clínica, y se asocia con una morbimortalidad significativa, la cual, en parte, se explica por el riesgo de fenómenos embólicos. En la actualidad, el uso de anticoagulantes es el estándar de manejo en aquellos pacientes con riesgo embólico significativo (dado por un puntaje ≥ 2 en la escala CHA2DS2Vasc). Sin embargo, algunos pacientes tienen contraindicaciones que impiden recibir este tipo de tratamiento a largo plazo, en cuyo caso se considera el cierre percutáneo de la orejuela como medida para la disminución del riesgo de embolia. Al requerir una punción transeptal, la presencia de dispositivos de cierre de defectos del septo interauricular dificulta el procedimiento de manera significativa. Se presenta el caso de una paciente con contraindicación absoluta para recibir anticoagulantes debido a sangrado gastrointestinal y antecedente de cierre percutáneo de comunicación interauricular sometida a cierre percutáneo de orejuela como alternativa terapéutica a la anticoagulación.
Abstract Atrial fibrillation is the most prevalent arrythmia in clinical practice, associated with a significant morbimortality explained, in part, by the high risk of embolic phenomena. The use of anticoagulation is the standard of care in those patients with increased embolic risk (given by a score ≥ 2 in the CHA2DS2Vasc scale). However, some patients have contraindications to receiving this treatment long-term, in which case percutaneous left atrial appendage occlusion can be considered as a means of decreasing their embolic risk. Because the procedure requires transeptal puncture, the presence of devices for atrial septal defect closure can difficult the technique. We present the case of a patient with absolute contraindication to anticoagulation therapy given gastrointestinal bleeding, with history of percutaneous closure of interauricular communication, who was treated with percutaneous left atrial appendage occlusion as an alternative to oral anticoagulants.
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Surgical exclusion of the left atrial appendage (LAA) for stroke prevention in atrial fibrillation is frequently incomplete and remains to be optimized. We present a man who did not tolerate anticoagulant and failed percutaneous occlusion. Intraoperative echocardiographic contrast was used to assist surgical exclusion. Follow?up showed a persistent occlusion.
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@#Objective To systematically evaluate the safety, efficacy, and economics of intracardiac echocardiography (ICE) versus transesophageal echocardiography (TEE) in left atrial appendage occlusion (LAAO). Methods PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Database were systematically searched to collect relevant studies on comparing ICE and TEE-guided LAAO from inception to June 15th, 2022. Two reviewers independently screened the literatures, extracted the data, and assessed the risk of bias of the included studies. Meta-analyses were performed using RevMan 5.3 and R 4.0.3. Retrospective cohort studies were excluded for sensitivity analysis. Subgroup analyses were performed based on the types of occluder and ICE catheter. Results A total of 14 studies with 6 599 patients were included. Meta-analyses showed no statistical differences in technical success rate, overall complications, device embolization, peri-device leakage, device-related thrombus, stroke, vascular complications, bleeding, operation time, fluoroscopy time, or contrast agent volume between the ICE and TEE-guided LAAO. The total in-room time (MD=–33.47 min, 95%CI –41.20 to –25.73, P<0.000 01) and radiation dosage (MD=–170.20 mGy, 95%CI –309.79 to –30.62, P=0.02) were lower in the ICE group than those in the TEE group, whereas the incidence of pericardial effusion/tamponade was higher than the TEE group (RR=1.57, 95%CI 1.01 to 2.45, P=0.048). Except for pericardial effusion/tamponade, subgroup analyses and sensitivity analysis showed similar results. The analysis based on the cost data from the United States showed comparable or even lower total costs for ICE versus TEE, but comparative domestic cost studies were lacking. Conclusion Current evidence suggests that ICE-guided LAAO can reduce radiation dosage and total in-room time, and there is no statistical difference in the overall complication rate between the two groups. Owing to the limitations of sample size and quality of the included studies, the conclusion still needs to be verified by large sample size and high-quality randomized controlled trials.
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Objective:To investigate the relationship of delayed cardiac tamponade (CT) after left atrial appendage closure (LAAC) in atrial fibrillation (AF) patients and implanted occluders and adjacent anatomical structures.Methods:This study was a retrospective study. Thirteen AF patients with LAAC complicated with delayed CT and with concurrent emergency pericardiocentesis drainage in Zhoupu Hospital, Shanghai University of Medicine & Health Sciences from August 2016 to June 2021 were selected. The follow-up time was (16±12) months. The clinical data of these patients were retrospectively analyzed, including the relationship between the left atrial appendage and pulmonary artery, vein anatomy by left atrium computed tomography angiography (CTA) before and after LAAC.Results:Thirteen patients with delayed CT were treated by pericardiocentesis and drainage after LAAC and aged (72.1±8.3) years, and 7 patients were male, Six patients received cryoablation simultaneously. The classification types of left atrial appendage included cauliflower and chicken wing types were 8 and 5 respectively. The seal plate diameter of the lobe-and-disc devices was (29.5±2.8)mm; 10 patients had cardiac CTA reviewed. The occluder was attached to pulmonary artery in 8 patients, attached to left superior pulmonary vein only in one patient, and attached to pulmonary artery and left superior pulmonary vein in one patient. The prognosis was good except one patient who died 2 days after LAAC.Conclusions:Delayed CT after LACC is closely related to the location of left atrial appendage adjacent to pulmonary artery and left superior pulmonary vein, and is related to larger occluder and anchor hook.
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Objective:To summarize the ultrasonophic features of left atrial appendage aneurysm, and to provide an important reference for the early and accurate diagnosis of left atrial appendage aneurysm.Methods:Patients with atrial appendage aneurysm have no obvious symptoms in the early stage, and there are many difficulties and challenges in diagnosis. This paper analyzed and summarized the diagnostic characteristics of a child with left atrial appendage aneurysm by combining the prenatal and postnatal ultrasonic imaging characteristics.Results:Echocardiography is the first choice for the diagnosis of left atrial appendage aneurysm. Some cases can make precise diagnosis prenatally.Conclusions:Echocardiography is the preferred imaging examination method for evaluating left atrial appendage aneurysm. Multimodal imaging technology can identify and diagnose left atrial appendage aneurysm early and accurately, and provide important basis for clinical diagnosis and treatment plan.
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Objective:To investigate the association between abnormal left atrial appendage function and thrombotic events in patients with non-valvular atrial fibrillation, and the independent risk factors affecting left atrial appendage function.Methods:Patients with non-valvular atrial fibrillation, who visited the Atrial Fibrillation Center of the First Affiliated Hospital of Xinjiang Medical University from June 1, 2019 to June 1, 2021, were selected. According to left atrial appendage flow velocity (LAAFV), they were divided into normal left atrial appendage function group (297 patients with LAAFV ≥ 40 cm/s) and abnormal left atrial appendage function group (85 patients with LAAFV<40 cm/s). Baseline data and transesophageal echocardiography images were collected from all the patients. The occurrence of thrombotic events was recorded. Univariate and multivariate unconditional logistic regression analyses were conducted to investigate the correlation between abnormal left atrial appendage function and the occurrence of thrombotic events.Results:There were significant differences in gender, type of atrial fibrillation, CHA 2DS 2-VASc score, anticoagulant therapy, total cholesterol, low-density lipoprotein cholesterol, international normalized ratio (INR), left atrial diameter, proportion of patients with right atrial enlargement, left ventricular ejection fraction, inner diameter, sum of inner diameter, depth, and sum of depth of all angles of the left atrial appendage, and incidence of thrombotic events between the two groups (all P<0.05). After adjusting for confounders, multivariate unconditional logistic regression analyses showed that abnormal left atrial appendage function was closely associated with thrombotic events (β=1.168 P=0.002), and left atrial diameter ( OR=1.084, 95% CI 1.019-1.153, P=0.011) and persistent atrial fibrillation ( OR=2.323, 95% CI 1.226-4.403, P=0.010) were independent risk factors affecting left atrial appendage function. Conclusions:Abnormal left atrial appendage function is closely associated with thrombosis. The left atrial diameter and persistent atrial fibrillation were independent risk factors affecting left atrial appendage function.
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Objective:To analyze the safety and efficacy of left atrial appendage closure(LAAC)with Watchman in patients ≥85 years with atrial fibrillation(AF).Methods:515 elderly patients with atrial fibrillation, including 73 patients aged 85 years or older(85~91), who had undergone Watchman LAAC at Zhoupu Hospital affiliated to Shanghai Health Medical College from August 2016 to December 2020, were retrospectively analyzed.Of those ≥85 years, 44(60.3%)with transesophageal echocardiography records were assigned to the elderly group.Fifty-three patients aged 60 to 65 were selected as the control group.Differences in baseline data, intraoperative conditions, antithrombotic treatment plans and 1-year follow-up prognosis were compared between the two groups.Results:Compared with the control group, there was no difference in AF types, history of ischemic stroke/transient ischaemic attack(all P>0.05), but there were higher incidences of coronary heart disease and renal insufficiency, more severe heart failure, higher CHA 2DS 2-VASC(6.0±1.5 vs.3.6±1.5), HAS-BLED(3.2±1.2 vs.2.3±1.3)scores( t values were 7.682 and 3.871, respectively, P<0.05), and a lower one-stop surgery rate(6 cases or 13.6% vs. 27 cases or 50.9%, χ2=10.517, P<0.05)in the advanced age group.There was no difference in the diameter of the Watchman device, rate of device replacement, compression percentage and residual flow between the two groups during the perioperative period.The incidences of device-related thrombosis were 4.5%(2/44)and 3.8%(2/53)for the advanced age group and the control group, respectively, but the difference was not statistically significant( P>0.05). During the 12-month follow-up, there were no cases of ischemic stroke or intracerebral hemorrhage.Three died of heart failure and 1 died of cancer. Conclusions:LAAC with Watchman is safe and effective for patients over 85 years with AF, but the decision on the procedure should be based on careful assessment of patients' cardiac and renal function and general health.
ABSTRACT
@#Objective To investigate the short-term efficacy and safety of thoracoscopy-assisted epicardial radiofrequency ablation for atrial fibrillation (AF) and/or left atrial appendage exclusion (LAAE). Methods The clinical data of 12 patients with solitary AF admitted to Beijing Tiantan Hospital from November 2018 to August 2020 were retrospectively analyzed, including 7 males and 5 females, with an average age of 65.2±5.3 years. Of them, 2 had paroxysmal AF, 1 had persistent AF and 9 had permanent AF. Results No patient died during hospitalization, 5 patients underwent radiofrequency ablation for AF and LAAE, and 6 received LAAE alone. The operation time was 293±70 min in radiofrequency ablation for AF+LAAE patients and 71±14 min in LAAE patients. Two patients restored sinus rhythm, two restored after electric cardioversion, and one remained AF in AF+LAAE patients. Postoperatively, 1 patient had pleural effusion and 1 had subcutaneous emphysema. No stroke was observed. Conclusion Thoracoscopy-assisted radiofrequency ablation for AF and/or LAAE reduce the risk of procedure, and provide alternative approach to treat AF-associated diseases. However, large sample size studies using prospective cohort designs are required to corroborate the present findings.