Incidence, predictors and outcomes of device-related thrombus after left atrial appendage closure with the WATCHMAN device-Insights from the EWOLUTION real world registry.

BACKGROUND: In this analysis of the EWOLUTION registry, we evaluated the incidence, relevance and predictors of device-related thrombus in a large multi-center real-world cohort undergoing LAAc with the WATCHMAN device. METHODS AND RESULTS: We analyzed the 835 patients who underwent percutaneous LAA closure with the WATCHMAN device in the EWOLUTION registry in whom at least one TEE follow up was performed. Patients were 74 ± 9 y/o and were at high risk for stroke and bleeding (CHA2DS2-VASC-Score 4.3 ± 1.7; HAS-BLED-Score 2.3 ± 1.2). Device-related thrombus was detected in 4.1% (34/835) after a median of 54 days (IQR 42-111 days) with 91.2% (31/34) being detected within 3 months after the procedure or at the time of first TEE. Hereby DRT occurred irrespective of postprocedural anticoagulation. Patients with DRT more frequently had long-standing, non-paroxysmal atrial fibrillation (82.4 vs. 64.9%, p < .01), evidence of dense spontaneous echo contrast (26.5 vs. 11.9%, p = .03) and larger LAA diameters at the ostium (22.8 ± 3.5 vs. 21.1 ± 3.5 mm, p < .01) compared to patients without DRT. Left ventricular ejection fraction, device compression ratio and the incidence of renal dysfunction did not differ between the two groups. In a multivariate analysis, only non-paroxysmal atrial fibrillation identified as an independent predictor of developing DRT. Specific treatment of DRT was initiated in 62% (21/34) of patients whereas resolution was confirmed in 86% (18/21) of cases. Overall, no significant differences in annual rates of stroke/TIA or systemic embolism were observed in patients with or without DRT (DRT 1.7 vs. No-DRT 2.2%/year, p = .8). CONCLUSIONS: In real-world patients undergoing LAAc with the WATCHMAN device, DRT is rare. DRT was most frequently detected within the first 3 months after LAAc regardless of post-procedural regimen and was not associated with an increased risk of stroke or SE. While long-standing atrial fibrillation was the only independent factor associated with DRT, medical treatment of DRT resulted in a resolution of thrombi in most cases.

Diagnosis of obstructive coronary artery disease by cardiogoniometry: a field test in a real-life setting.

Cardiogoniometry is an electrocardiographic and vectorcardiographic method utilizing computer-assisted analysis of cardiac potentials focusing on T-wave abnormalities resulting from myocardial malperfusion. We describe a case of diagnosis of obstructive coronary artery disease with this method and discuss the possible implications for the clinical setting.

[Primary Coronary Intervention (PCI) within the myocardial infarction network system in a German city (Essen)]. / Akutintervention (Primär-PCI) im Rahmen des Essener Herzinfarktverbundes.

In a German city (Essen, 490,000 people), a new network system for patients with ST elevation myocardial infarction (STEMI) was established in 2004. This included a so-called integrated care model (IV model) by participation of insurance companies. In a cooperative structure between invasive and noninvasive hospitals, general practitioners and cardiologists as well as emergency systems it could be realized, that every patient with STEMI will be treated by primary percutaneous coronary intervention (PCI) as soon as possible according to the current guidelines. The patient characteristics (age, gender, comorbidity, medication) were comparable to other trials and registries. The primary success rate was high (96.4%). The acute in-hospital results demonstrated a low mortality (7.6%). The time periods of delay were comparable to other registries. The symptom-to-balloon time was 239 min, the medical contact-to-balloon time 95 min, the door-to-balloon time 60 min, and the puncture-to-balloon time 18 min (median values). The STEMI network system in Essen demonstrates the possibility of modern therapy in patients with myocardial infarction (primary PCI) in a cooperative modality between all participants in the health-care system.