Long-term follow-up after left atrial appendage occlusion with comparison of transesophageal echocardiography versus computed tomography to guide medical therapy and data about postclosure cardioversion

Autor: Christoph Scharf, Monica Pfyffer, Barbara Naegeli, Dominik Maurer, Anja Fah-Gunz, Christine H. Attenhofer Jost, Xavier Pillois, Benjamin Berte, Gabor Sütsch
Rok vydání: 2017
Předmět:
Male
medicine.medical_specialty
Septal Occluder Device
medicine.medical_treatment
Electric Countershock
030204 cardiovascular system & hematology
Transesophageal echocardiogram
Cardioversion
Left atrial appendage occlusion
Multimodal Imaging
03 medical and health sciences
Blood Vessel Prosthesis Implantation
0302 clinical medicine
Postoperative Complications
Blood vessel prosthesis
Predictive Value of Tests
Physiology (medical)
Internal medicine
Atrial Fibrillation
medicine
Humans
Atrial Appendage
030212 general & internal medicine
Prospective Studies
Prospective cohort study
Stroke
Aged
medicine.diagnostic_test
business.industry
Atrial fibrillation
Middle Aged
medicine.disease
Surgery
Blood Vessel Prosthesis
Treatment Outcome
Cardiology
Female
Tamponade
Cardiology and Cardiovascular Medicine
business
Tomography
X-Ray Computed
Echocardiography
Transesophageal
Follow-Up Studies
Zdroj: Journal of cardiovascular electrophysiology. 28(10)
ISSN: 1540-8167
Popis: Aims The use of left atrial appendage (LAA)-occluders in atrial fibrillation is increasing. There are few data on the comparison between transesophageal echocardiography (TEE) and computed tomography (MDCT) assessing peridevice-flow and outcome of electrical cardioversion (ECV) in these patients. Methods and results Single-center prospective registry from 2009 to 2015 including all LAA-occluders to analyze success and complications during implantation and follow-up. Patients having ≥1 ECV were further analyzed. TEE was performed during implantation and at 6weeks. In a subgroup of 77patients, we compared MDCT with TEE at 6weeks. Overall, 135patients (69±9years; 70% male; CHA2DS2-VASc score: 3.6±1.4; HAS-BLED score: 2.5±0.6) received a LAA-occluder (Watchman, n = 73; ACP-1, n = 59; Amulet, n = 3; PVI+LAA-occluder, n = 91 and LAA-occluder-only, n = 44). Device implantation was successful in 131 (97%). Eight patients (5.9%) had major periprocedural complications (ischemic stroke/transient ischemic attacks, n = 4, tamponade, n = 2, device thrombosis, n = 2, Dressler syndrome, n = 1). The periprocedural complication rate was similar between concomitant procedure and LAA-occluder-only (8/91 vs. 5/44; p = 0.6). Twelve patients (9%) died (procedure-related, n = 2; 1%) during follow-up of 44 months (IQR:43). MDCT (n = 77) at 6weeks showed similar peridevice-flow compared to TEE (TEE: 1.5±1.9mm vs. MDCT: 1.1± 2.2mm, p = 0.25. Thromboembolic events occurred in 3patients (CVA, n = 1;TIA, n = 2) during follow-up. In total, 41 ECV were performed in 26 patients (1.6±0.9/pt) 13 months (IQR: 24) after implantation (
Databáze: OpenAIRE
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