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Initial experience with post Lariat left atrial appendage leak closure with Amplatzer septal occluder device and repeat Lariat application
Left atrial appendage (LAA) ligation with the Lariat device is a therapeutic option to prevent thromboembolic stoke in patients with nonvalvular atrial fibrillation (AF) at high risk for systemic thromboembolization and bleeding related to use of anticoagulation. In rare cases, this procedure could leave the LAA incompletely ligated with continued risk of stroke.
Source: Heart Rhythm - June 30, 2014 Category: Cardiology Authors: Anand M. Pillai, Arun Kanmanthareddy, Matthew Earnest, Madhu Reddy, Ryan Ferrell, Jayanth Nath, Jayasree Pillarisetti, Ajay Vallakati, Dhanunjaya Lakkireddy Source Type: research

EWOLUTION – The Next Evolution in Appendage Closure?
Oral anticoagulation (OAC) is a class I indication for patients with non-valvular atrial fibrillation (AF) and 2 or more risk factors for stroke.1 However, many patients with AF are ineligible for OAC due to prohibitive bleeding. Subsequently, as a result of the pivotal role of the left atrial appendage (LAA) in the formation of thrombi, an alternative strategy to OAC is occlusion of the LAA.2 The WATCHMAN device (Boston Scientific Corporation, Marlborough, Massachusetts) is the only FDA approved LAA occlusion product studied in the randomized control trials (RCT) (Table 1).
Source: Heart Rhythm - June 22, 2017 Category: Cardiology Authors: Muhammad R. Afzal, Emile G. Daoud Source Type: research

EWOLUTION —The next evolution in appendage closure?
Oral anticoagulation (OAC) is a class I indication for patients with nonvalvular atrial fibrillation (AF) and ≥2 risk factors for stroke.1 However, many patients with AF are ineligible for OAC because of prohibitive bleeding. Subsequently, as a result of the pivotal role of the left atrial appendage (LAA) in the formation of thrombi, an alternative strategy to OAC is occlusion of the LAA.2 The WATCHMAN de vice (Boston Scientific Corporation, Marlborough, MA) is the only US Food and Drug Administration (FDA)–approved LAA occlusion product that has been studied in randomized control trials (RCTs) (Table).
Source: Heart Rhythm - June 22, 2017 Category: Cardiology Authors: Muhammad R. Afzal, Emile G. Daoud Tags: Editorial Commentary Source Type: research

Renal function and risk of stroke and bleeding in patients undergoing catheter ablation for atrial fibrillation: comparison between uninterrupted direct oral anticoagulants and warfarin administration
The effect of uninterrupted oral anticoagulant use in patients with chronic kidney disease (CKD) during catheter ablation for atrial fibrillation (AF) is not fully understood.
Source: Heart Rhythm - October 26, 2017 Category: Cardiology Authors: Satoshi Yanagisawa, Yasuya Inden, Aya Fujii, Monami Ando, Junya Funabiki, Yosuke Murase, Masaki Takenaka, Noriaki Otake, Yoshihiro Ikai, Yusuke Sakamoto, Rei Shibata, Toyoaki Murohara Source Type: research

EP News: Allied Professionals
Using data on patients in the United States Renal Data System (USRDS), Siontis et  al (Circulation 2018; https://doi.org/10.1161/CIRCULATIONAHA.118.035418 [Epub ahead of print], PMID 29954737) sought to assess patterns of apixaban use and outcomes related to use of anticoagulants in patients with end-stage renal disease (ESRD) and atrial fibrillation (AF). As background, patient s with ESRD have both higher risk of bleeding and higher risk of stroke with AF. The Food and Drug Administration has approved updated labeling for the use of apixaban in patients with ESRD on the basis of a small pharmacokinetic study.
Source: Heart Rhythm - July 26, 2018 Category: Cardiology Authors: Erica S. Zado Tags: EP News Source Type: research

Accessory Pulmonary Vein Insertion into the Left Atrial Appendage Revealed During Intended Interventional LAA Occlusion
A 64-year-old male with paroxysmal atrial fibrillation and a recent stroke presented with internal carotid artery re-stenosis after prior angioplasty. Cardiovascular risk factors included arterial hypertension, hyperlipidemia, obesity, positive family history, heart failure, and active smoking. Due to high risk of cerebral ischemia as well as periinterventional bleeding complications, the patient was scheduled for interventional left atrial appendage (LAA) closure prior to carotid artery surgery.
Source: Heart Rhythm - July 30, 2018 Category: Cardiology Authors: Octavian Maniuc, Jonas M üntze, Maria Moritz, Peter Nordbeck Source Type: research

Net Clinical Benefit of Anticoagulant Treatments in Elderly Patients with Non-Valvular Atrial Fibrillation: Experience From the Real World
Oral anticoagulation (OAC) is effective in stroke prevention in elderly patients with non-valvular atrial fibrillation (AF), but older patients are also at greater risk of bleeding.
Source: Heart Rhythm - August 17, 2018 Category: Cardiology Authors: Hilmi Alnsasra, Moti Haim, Adi Berliner Senderey, Orna Reges, Maya Leventer-Roberts, Yoav Arnson, Morton Leibowitz, Moshe Hoshen, Meytal Avgil-Tsadok Source Type: research

Net clinical benefit of anticoagulant treatments in elderly patients with nonvalvular atrial fibrillation: Experience from the real world
Oral anticoagulation (OAC) is effective in stroke prevention in elderly patients with nonvalvular atrial fibrillation (AF), but older patients are also at higher risk of bleeding.
Source: Heart Rhythm - August 17, 2018 Category: Cardiology Authors: Hilmi Alnsasra, Moti Haim, Adi Berliner Senderey, Orna Reges, Maya Leventer-Roberts, Yoav Arnson, Morton Leibowitz, Moshe Hoshen, Meytal Avgil-Tsadok Source Type: research

EP News: Clinical
Sindet-Pedersen et  al (J Am Coll Cardiol 2018;72:1790, PMID 30286922) investigated the risk of bleeding, ischemic stroke, myocardial infarction (MI), and all-cause mortality associated with direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in combination with aspirin, clopidogrel, or both in patients with atrial fibrillation (AF) after MI and/or percutaneous coronary intervention (PCI). Overall, 3222 patients were included in the retrospective registry analysis; 875 (27%) were treated with VKA+single antiplatelet therapy (SAPT), 595 (18%) were treated with DOAC+SAPT, 1074 (33%) were treated wi...
Source: Heart Rhythm - November 23, 2018 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

Thromboembolic, Bleeding, and Mortality Risks among Patients with Nonvalvular Atrial Fibrillation Treated with Dual Antiplatelet Therapy versus Oral Anticoagulants: A Population-Based Study
Dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel is used for stroke prevention in patients with atrial fibrillation (AF) when patients refuse to use oral anticoagulants (OAC) in clinical practice. However, there are limited clinical data comparing these treatments.
Source: Heart Rhythm - July 31, 2019 Category: Cardiology Authors: Wallis C.Y. Lau, Ian J. Douglas, Ian C.K. Wong, Liam Smeeth, Gregory Y.H. Lip, Wai K. Leung, Chung-Wah Siu, Bernard M.Y. Cheung, Michael T.C. Mok, Esther W. Chan Source Type: research

EP News Clinical July 1, 2020
Osmancik and colleagues (J Am Coll Cardiol. 2020; 75:3122-3135. PMID: 32586585) compared left atrial appendage closure (LAAC) with direct oral anticoagulants in a multicenter, randomized, noninferiority trial. A high-risk patient cohort (CHA2DS2-VASc: 4.7 ± 1.5) was randomized to receive LAAC (n = 201) or DOAC (n = 201). At 19.9 months of follow-up, the annual rates of the primary outcome were 10.99% with LAAC and 13.42% with DOAC (HR: 0.84; p = 0.44; p = 0.004 for noninferiority). There were no differences between groups for the components of the c omposite endpoint: all-stroke/TIA (HR: 1.00), clinically significant blee...
Source: Heart Rhythm - July 3, 2020 Category: Cardiology Authors: N. A. Mark Estes Source Type: research

EP News: Clinical
Osmancik and colleagues (J Am Coll Cardiol 2020;75:3122 –3135, PMID 32586585) compared left atrial appendage closure (LAAC) with direct oral anticoagulants (DOAC) in a multicenter, randomized, noninferiority trial. A high-risk patient cohort (CHA2DS2-VASc: 4.7 ± 1.5) was randomized to receive LAAC (n = 201) or DOAC (n = 201). At 19.9 months of follow- up, the annual rates of the primary outcome were 10.99% with LAAC and 13.42% with DOAC (d ratio [HR]: 0.84; P = .44; P = .004 for noninferiority). There were no differences between groups for the components of the composite endpoint: all-stroke/transient ischemic attack (H...
Source: Heart Rhythm - July 3, 2020 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

Strategies to balance stroke and bleeding risk in patients with atrial fibrillation and cancer
A 76-year-old female with obesity, hypertension, persistent atrial fibrillation, and heart failure with preserved ejection fraction is started on ibrutinib 420 mg once daily for Waldenstrom ’s macroglobulinemia. Due to concern for drug-drug interactions, her amiodarone is decreased from 200 to 100 mg daily, and she is continued on metoprolol succinate 100 mg daily and apixaban 5 mg twice daily. She presents to the clinic one month later with extensive superficial ecchymoses, and her apixaban dose is reduced to 2.5 mg twice daily due to concerns that this may reflect the combined antiplatelet effects of ibrutinib and anti...
Source: Heart Rhythm - April 27, 2021 Category: Cardiology Authors: Shiv Bagga, Sourbha S. Dani, Bruce G. Hook, Anju Nohria, Sarju Ganatra Source Type: research

B-po03-152 left atrial appendage occlusion in patients with intracranial hemorrhage
Patients with prior intracranial hemorrhage (ICH) and atrial fibrillation (AF) are at increased risk of recurrent bleeding; and often not treated with oral anticoagulation despite high risk of ischemic stroke.
Source: Heart Rhythm - July 28, 2021 Category: Cardiology Authors: Jalaj Garg, Siddharth Shah, Kuldeep Bharat Shah, Mohit K. Turagam, Andrea Natale, Dhanunjaya R. Lakkireddy Source Type: research

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