For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-ter...For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-term oral anticoagulation.Incomplete closure of the LAAC during the procedure leads to faster blood flow in the interstitial space around the device,resulting in peri-device leak(PDL),which is not uncommon.Studies are still inconclusive in determining the incidence,long-term safety,and management of PDL.Therefore,this article reviewed the progress made in the research and treatment of PDL after LAAC.展开更多
Atrial fibrillation prevalence is increasing with age, reaching up to 5% of patients older than 65 years, and is associated with 20%-30% of stroke episodes in that population.
An atrial septal defect (ASD) may cause right heart dysfunction, pulmonary hypertension and atrial fibrillation (AF), and atrial septal defect occlusion (ASDO) is the first choice for treating secundum defects when th...An atrial septal defect (ASD) may cause right heart dysfunction, pulmonary hypertension and atrial fibrillation (AF), and atrial septal defect occlusion (ASDO) is the first choice for treating secundum defects when the morphology permits. ASD and AF frequently coexist, and the risk of AF and stroke persists after ASDO.[1] In recent years, left atrial appendage occlusion (LAAO) has been recognized as an effective treatment for stroke prevention in nonvalvular AF patients with a high risk of stroke, systemic embolism and bleeding who are unwilling to take oral anticoagulants or cannot tolerate them.展开更多
Background Cryoballoon ablation has been demonstrated to be an effective way for the treatment of atrial fibrilation(AF).However,in the population with high risk of thromboembolism,long-term oral anticoagulants are st...Background Cryoballoon ablation has been demonstrated to be an effective way for the treatment of atrial fibrilation(AF).However,in the population with high risk of thromboembolism,long-term oral anticoagulants are still in need,which lead to the odds of hemorrhage.As previous studies confirmed,left atrial appendage closure(LAAC)could decrease the risk of thromboembolism in AF patients,and may substitute for the long term anticoagulation.Therefore,we attempted to combine both these operations for AF.展开更多
Background It’s essential to prevent from thrombosis on device without increasing the risk of bleeding complications after successfully implanted left atrial appendage device.At present,no guidelines recommend about ...Background It’s essential to prevent from thrombosis on device without increasing the risk of bleeding complications after successfully implanted left atrial appendage device.At present,no guidelines recommend about postoperative antithrombotic therapy of left atrial appendage closure(LAAC).The purpose of this study is to investigate the safety and efficacy of different antithrombotic therapies after LAAC.展开更多
The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy(CAA)and atrial fibrilla...The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy(CAA)and atrial fibrillation(AF).In fact,CAA is an age-related cerebral vasculopathy that predisposes patients to intracerebral hemorrhage.Nevertheless,many AF patients require oral systemic dose-adjusted warfarin,direct oral anticoagulants(such as factor Xa inhibitors)or direct thrombin inhibitors to control often associated with cardioembolic stroke risk.The prevalence of both CAA and AF is expected to rise,due to the aging of the population.This clinical dilemma is becoming increasingly common.In patients with coexisting AF and CAA,the risks/benefits profile of anticoagulant therapy must be assessed for each patient individually due to the lack of a clear-cut consensus with regard to its risks in scientific literature.This review aims to provide an overview of the management of patients with concomitant AF and CAA and proposes the implementation of a risk-based decision-making algorithm.展开更多
Transcatheter closure of the left atrial appendage with the Amplatzer cardiac plug device and double antiplatelet treatment for 3 mo has become an alternative treatment for patients with atrial fibrillation at high em...Transcatheter closure of the left atrial appendage with the Amplatzer cardiac plug device and double antiplatelet treatment for 3 mo has become an alternative treatment for patients with atrial fibrillation at high embolism risk and contraindications for chronic oral anticoagulation.The inadequate implantation of the left atrial appendage closure device and the discontinuation of double antiplatelet therapy are well-known as factors related to device thrombosis.Nevertheless,device thrombosis after adequate implantation requiring surgical treatment or restarting chronic oral anticoagulation has been reported and can reach 15% of patients.The connector pin thrombosis of the Amplatzer cardiac plug,despite a good adherence to antiplatelet treatment,has been recently described as a potential mechanism for device thrombosis.Our clinical case reports the management of this condition for the first time,showing that the early detection of thrombotic complications by transesophageal echocardiography permits solving this serious complication with medical treatment only.展开更多
Atrial fibrillation （AF） is the most common cardiac ar-rhythmia in clinical practice with an increasing incidenceand prevalence. With ageing, the risk of thromboembolicand hemorrhagic events increases dramatically. ...Atrial fibrillation （AF） is the most common cardiac ar-rhythmia in clinical practice with an increasing incidenceand prevalence. With ageing, the risk of thromboembolicand hemorrhagic events increases dramatically. As it hasbeen reported previously, 3-year survival rate among pa-tients with AF over 75 years of age after stroke is less than50%, and almost 90% of those patients will remain dis-abled.展开更多
Background:Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure(LAAC)is increasingly used for stroke prevention in patients with atrial fibrillation(AF).We aimed to observe the fe...Background:Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure(LAAC)is increasingly used for stroke prevention in patients with atrial fibrillation(AF).We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single(one-stop)procedure.Methods:Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled.Baseline and intra-procedural parameters were evaluated.Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects,respectively.Results:A total of 178 AF patients(94 males,68.9±8.1 years)underwent the one-stop procedure with CHA2DS2-VASc score 3.3±1.5 and HAS-BLED score 1.6±1.0,respectively.Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary,yielding immediate ablation success rate of 98.9%(176/178).In the subsequent LAAC,satisfactory seal(residual leak<5 mm)was achieved in all patients.One stroke and four cardiac perforations occurred peri-operatively.At 3-month follow-up,sinus rhythm and satisfactory seal were maintained in 153/178(86.0%)and 178/178(100%)patients,respectively.One stroke and one delayed cardiac tamponade occurred,while no device-related thrombus or device migration was observed.During the 1-year follow-up for the earlier enrolled subjects,52/72(72.2%)of the patients maintained sinus rhythm.There was no stroke or systemic embolism observed.Conclusion:Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.展开更多
基金Supported by Zhejiang Provincial Foundation for Medical and Health Sciences,No.2021KY980.
文摘For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-term oral anticoagulation.Incomplete closure of the LAAC during the procedure leads to faster blood flow in the interstitial space around the device,resulting in peri-device leak(PDL),which is not uncommon.Studies are still inconclusive in determining the incidence,long-term safety,and management of PDL.Therefore,this article reviewed the progress made in the research and treatment of PDL after LAAC.
文摘Atrial fibrillation prevalence is increasing with age, reaching up to 5% of patients older than 65 years, and is associated with 20%-30% of stroke episodes in that population.
文摘An atrial septal defect (ASD) may cause right heart dysfunction, pulmonary hypertension and atrial fibrillation (AF), and atrial septal defect occlusion (ASDO) is the first choice for treating secundum defects when the morphology permits. ASD and AF frequently coexist, and the risk of AF and stroke persists after ASDO.[1] In recent years, left atrial appendage occlusion (LAAO) has been recognized as an effective treatment for stroke prevention in nonvalvular AF patients with a high risk of stroke, systemic embolism and bleeding who are unwilling to take oral anticoagulants or cannot tolerate them.
文摘Background Cryoballoon ablation has been demonstrated to be an effective way for the treatment of atrial fibrilation(AF).However,in the population with high risk of thromboembolism,long-term oral anticoagulants are still in need,which lead to the odds of hemorrhage.As previous studies confirmed,left atrial appendage closure(LAAC)could decrease the risk of thromboembolism in AF patients,and may substitute for the long term anticoagulation.Therefore,we attempted to combine both these operations for AF.
文摘Background It’s essential to prevent from thrombosis on device without increasing the risk of bleeding complications after successfully implanted left atrial appendage device.At present,no guidelines recommend about postoperative antithrombotic therapy of left atrial appendage closure(LAAC).The purpose of this study is to investigate the safety and efficacy of different antithrombotic therapies after LAAC.
文摘The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy(CAA)and atrial fibrillation(AF).In fact,CAA is an age-related cerebral vasculopathy that predisposes patients to intracerebral hemorrhage.Nevertheless,many AF patients require oral systemic dose-adjusted warfarin,direct oral anticoagulants(such as factor Xa inhibitors)or direct thrombin inhibitors to control often associated with cardioembolic stroke risk.The prevalence of both CAA and AF is expected to rise,due to the aging of the population.This clinical dilemma is becoming increasingly common.In patients with coexisting AF and CAA,the risks/benefits profile of anticoagulant therapy must be assessed for each patient individually due to the lack of a clear-cut consensus with regard to its risks in scientific literature.This review aims to provide an overview of the management of patients with concomitant AF and CAA and proposes the implementation of a risk-based decision-making algorithm.
文摘Transcatheter closure of the left atrial appendage with the Amplatzer cardiac plug device and double antiplatelet treatment for 3 mo has become an alternative treatment for patients with atrial fibrillation at high embolism risk and contraindications for chronic oral anticoagulation.The inadequate implantation of the left atrial appendage closure device and the discontinuation of double antiplatelet therapy are well-known as factors related to device thrombosis.Nevertheless,device thrombosis after adequate implantation requiring surgical treatment or restarting chronic oral anticoagulation has been reported and can reach 15% of patients.The connector pin thrombosis of the Amplatzer cardiac plug,despite a good adherence to antiplatelet treatment,has been recently described as a potential mechanism for device thrombosis.Our clinical case reports the management of this condition for the first time,showing that the early detection of thrombotic complications by transesophageal echocardiography permits solving this serious complication with medical treatment only.
文摘Atrial fibrillation （AF） is the most common cardiac ar-rhythmia in clinical practice with an increasing incidenceand prevalence. With ageing, the risk of thromboembolicand hemorrhagic events increases dramatically. As it hasbeen reported previously, 3-year survival rate among pa-tients with AF over 75 years of age after stroke is less than50%, and almost 90% of those patients will remain dis-abled.
基金This work was supported by grants from the State Key Program of National Natural Science Foundation of China(No.81530015)Clinical Research Plan of SHDC(No.16CR2019A).
文摘Background:Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure(LAAC)is increasingly used for stroke prevention in patients with atrial fibrillation(AF).We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single(one-stop)procedure.Methods:Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled.Baseline and intra-procedural parameters were evaluated.Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects,respectively.Results:A total of 178 AF patients(94 males,68.9±8.1 years)underwent the one-stop procedure with CHA2DS2-VASc score 3.3±1.5 and HAS-BLED score 1.6±1.0,respectively.Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary,yielding immediate ablation success rate of 98.9%(176/178).In the subsequent LAAC,satisfactory seal(residual leak<5 mm)was achieved in all patients.One stroke and four cardiac perforations occurred peri-operatively.At 3-month follow-up,sinus rhythm and satisfactory seal were maintained in 153/178(86.0%)and 178/178(100%)patients,respectively.One stroke and one delayed cardiac tamponade occurred,while no device-related thrombus or device migration was observed.During the 1-year follow-up for the earlier enrolled subjects,52/72(72.2%)of the patients maintained sinus rhythm.There was no stroke or systemic embolism observed.Conclusion:Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.
