Follow-up imaging after left atrial appendage closure
| Autor: | Yoshinari Enomoto, Sam Hanon, Kenji Kuroki, Marc A. Miller, Srinivas R. Dukkipati, Crystal B. Ducharme, William Whang, Subbarao Choudry, Shephal K. Doshi, Noelle Langan, Vivek Y. Reddy, Jacob S. Koruth, Aamir Sofi, Sarina Vanderzee, Betsy Ellsworth |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Cardiac Catheterization medicine.drug_class medicine.medical_treatment 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Valve replacement Physiology (medical) Atrial Fibrillation Medicine Humans Atrial Appendage 030212 general & internal medicine Embolization Registries Thrombus Cardiac Surgical Procedures Aged Aged 80 and over Aspirin business.industry Anticoagulant Atrial fibrillation medicine.disease Clopidogrel Surgery Cohort Female Cardiology and Cardiovascular Medicine business Echocardiography Transesophageal medicine.drug Follow-Up Studies |
| Zdroj: | Heart rhythm. 17(11) |
| ISSN: | 1556-3871 |
| Popis: | Background Because device-related thrombus (DRT) portends a poor prognosis after left atrial appendage closure with the Watchman device, surveillance transesophageal echocardiography (TEE) is recommended at 45 days and 1 year. However, oral anticoagulants are just discontinued at 45 days, rendering this early TEE unlikely to detect DRT. Indeed, DRT is most likely to occur after instituting aspirin monotherapy. Objective The purpose of this study was to evaluate the alternative strategy of first TEE imaging (or computed tomography) at 4 months post–Watchman implantation. Methods After Food and Drug Administration approval, consecutive patients undergoing Watchman implantation at 2 centers received TEE or CT at 4 months and 1 year, along with a truncated drug regimen: 6 weeks of an oral anticoagulant (or clopidogrel in a subset) plus aspirin, then 6 weeks of dual antiplatelet therapy, and finally aspirin monotherapy. Results Of the 530-patient cohort (mean age 78.7±7.9 years; 65.5% (n = 347) male; CHA2DS2-VASc score 4.5±1.4), 465 patients (87.7%) received 4-month imaging: 83.0% (440 of 530) TEE and 4.7% (25 of 530) computed tomography. Over a median follow-up of 12 months, 16 ischemic strokes (ISs), 8 transient ischemic attacks, and 1 systemic embolization occurred. Importantly, no IS occurred between 45 days and 4 months; the sole transient ischemic attack in this period (at ∼2 months) occurred 1 week after transcatheter aortic valve replacement. DRT was detected in 2.4% (11 of 465) at 4 months and 0.9% (2 of 214) at 1 year. No IS, but 1 leg embolization, was observed after DRT detection. Conclusion Delaying the first imaging post-Watchman implantation to 4 months was associated with no IS between 45 days and 4 months, the “vulnerable” period of this follow-up strategy. |
| Databáze: | OpenAIRE |
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