Outcome of left atrial appendage occlusion in high-risk patients

Research output: Contribution to journalArticle

Standard

Outcome of left atrial appendage occlusion in high-risk patients. / Masoud, Ahmed; Bartoletti, Stefano; Fairbairn, Timothy; Khurana, Ayush; Velavan, Periaswamy; Morrison, William Lindsay; Khalatbari, Afshin; Aggarwal, Suneil; Sharma, Nikhill; Kirchhof, Paulus; Gupta, Dhiraj.

In: Heart, Vol. 104, No. 7, 09.11.2018, p. 594-599.

Research output: Contribution to journalArticle

Harvard

Masoud, A, Bartoletti, S, Fairbairn, T, Khurana, A, Velavan, P, Morrison, WL, Khalatbari, A, Aggarwal, S, Sharma, N, Kirchhof, P & Gupta, D 2018, 'Outcome of left atrial appendage occlusion in high-risk patients', Heart, vol. 104, no. 7, pp. 594-599. https://doi.org/10.1136/heartjnl-2017-312383

APA

Masoud, A., Bartoletti, S., Fairbairn, T., Khurana, A., Velavan, P., Morrison, W. L., Khalatbari, A., Aggarwal, S., Sharma, N., Kirchhof, P., & Gupta, D. (2018). Outcome of left atrial appendage occlusion in high-risk patients. Heart, 104(7), 594-599. https://doi.org/10.1136/heartjnl-2017-312383

Vancouver

Masoud A, Bartoletti S, Fairbairn T, Khurana A, Velavan P, Morrison WL et al. Outcome of left atrial appendage occlusion in high-risk patients. Heart. 2018 Nov 9;104(7):594-599. https://doi.org/10.1136/heartjnl-2017-312383

Author

Masoud, Ahmed ; Bartoletti, Stefano ; Fairbairn, Timothy ; Khurana, Ayush ; Velavan, Periaswamy ; Morrison, William Lindsay ; Khalatbari, Afshin ; Aggarwal, Suneil ; Sharma, Nikhill ; Kirchhof, Paulus ; Gupta, Dhiraj. / Outcome of left atrial appendage occlusion in high-risk patients. In: Heart. 2018 ; Vol. 104, No. 7. pp. 594-599.

Bibtex

@article{054f9afec0e24d1590946104f590a2e1,
title = "Outcome of left atrial appendage occlusion in high-risk patients",
abstract = "OBJECTIVE: Percutaneous left atrial appendage (LAA) occlusion can be an interventional alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation.METHODS: We delivered LAA occlusion therapy using a standardised approach to patient referral, multidisciplinary team assessment, implant criteria, imaging and follow-up. We analysed patient characteristics, efficacy and safety of the implant procedure, and 12-month outcomes.RESULTS: Of 143 referrals from October 2014 to December 2016, 83 patients (age 76±8years, 32.5% female, mean CHAD2S2-VASc score 4 ±1) were offered LAA occlusion. Eighty (95.3%) had previous major bleeding (intracranial in 59%). LAA occluder implantation with an Amulet device was successful in 82 (98.8%), with periprocedural major adverse events occurring in 5 (6.0%) patients (2 device embolisations including 1 death, 2 major bleeds). Cardiac imaging in 75 (94%) patients 2months following implant showed device-related thrombus in 1 case (1.3%) and minor (<5mm) device leaks in 13 (17.1%). Over a median 12-month follow-up, 3 (3.8%) ischaemic strokes, 2 (2.5%) haemorrhagic strokes and 5 (6.3%) major extracranial bleeds occurred. All-cause mortality was 10%, with most deaths (7, 87.5%) due to non-cardiovascular causes.CONCLUSIONS: LAA occlusion may be a reasonable option for stroke prevention inhigh-risk patients with atrial fibrillation ineligible for anticoagulation. However, procedural complication rates are not insignificant, and patients remain at risk of serious adverse events and death even after successful implant.",
author = "Ahmed Masoud and Stefano Bartoletti and Timothy Fairbairn and Ayush Khurana and Periaswamy Velavan and Morrison, {William Lindsay} and Afshin Khalatbari and Suneil Aggarwal and Nikhill Sharma and Paulus Kirchhof and Dhiraj Gupta",
note = "{\textcopyright} Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.",
year = "2018",
month = nov
day = "9",
doi = "10.1136/heartjnl-2017-312383",
language = "English",
volume = "104",
pages = "594--599",
journal = "Heart",
issn = "1355-6037",
publisher = "BMJ Publishing Group",
number = "7",

}

RIS

TY - JOUR

T1 - Outcome of left atrial appendage occlusion in high-risk patients

AU - Masoud, Ahmed

AU - Bartoletti, Stefano

AU - Fairbairn, Timothy

AU - Khurana, Ayush

AU - Velavan, Periaswamy

AU - Morrison, William Lindsay

AU - Khalatbari, Afshin

AU - Aggarwal, Suneil

AU - Sharma, Nikhill

AU - Kirchhof, Paulus

AU - Gupta, Dhiraj

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2018/11/9

Y1 - 2018/11/9

N2 - OBJECTIVE: Percutaneous left atrial appendage (LAA) occlusion can be an interventional alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation.METHODS: We delivered LAA occlusion therapy using a standardised approach to patient referral, multidisciplinary team assessment, implant criteria, imaging and follow-up. We analysed patient characteristics, efficacy and safety of the implant procedure, and 12-month outcomes.RESULTS: Of 143 referrals from October 2014 to December 2016, 83 patients (age 76±8years, 32.5% female, mean CHAD2S2-VASc score 4 ±1) were offered LAA occlusion. Eighty (95.3%) had previous major bleeding (intracranial in 59%). LAA occluder implantation with an Amulet device was successful in 82 (98.8%), with periprocedural major adverse events occurring in 5 (6.0%) patients (2 device embolisations including 1 death, 2 major bleeds). Cardiac imaging in 75 (94%) patients 2months following implant showed device-related thrombus in 1 case (1.3%) and minor (<5mm) device leaks in 13 (17.1%). Over a median 12-month follow-up, 3 (3.8%) ischaemic strokes, 2 (2.5%) haemorrhagic strokes and 5 (6.3%) major extracranial bleeds occurred. All-cause mortality was 10%, with most deaths (7, 87.5%) due to non-cardiovascular causes.CONCLUSIONS: LAA occlusion may be a reasonable option for stroke prevention inhigh-risk patients with atrial fibrillation ineligible for anticoagulation. However, procedural complication rates are not insignificant, and patients remain at risk of serious adverse events and death even after successful implant.

AB - OBJECTIVE: Percutaneous left atrial appendage (LAA) occlusion can be an interventional alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation.METHODS: We delivered LAA occlusion therapy using a standardised approach to patient referral, multidisciplinary team assessment, implant criteria, imaging and follow-up. We analysed patient characteristics, efficacy and safety of the implant procedure, and 12-month outcomes.RESULTS: Of 143 referrals from October 2014 to December 2016, 83 patients (age 76±8years, 32.5% female, mean CHAD2S2-VASc score 4 ±1) were offered LAA occlusion. Eighty (95.3%) had previous major bleeding (intracranial in 59%). LAA occluder implantation with an Amulet device was successful in 82 (98.8%), with periprocedural major adverse events occurring in 5 (6.0%) patients (2 device embolisations including 1 death, 2 major bleeds). Cardiac imaging in 75 (94%) patients 2months following implant showed device-related thrombus in 1 case (1.3%) and minor (<5mm) device leaks in 13 (17.1%). Over a median 12-month follow-up, 3 (3.8%) ischaemic strokes, 2 (2.5%) haemorrhagic strokes and 5 (6.3%) major extracranial bleeds occurred. All-cause mortality was 10%, with most deaths (7, 87.5%) due to non-cardiovascular causes.CONCLUSIONS: LAA occlusion may be a reasonable option for stroke prevention inhigh-risk patients with atrial fibrillation ineligible for anticoagulation. However, procedural complication rates are not insignificant, and patients remain at risk of serious adverse events and death even after successful implant.

U2 - 10.1136/heartjnl-2017-312383

DO - 10.1136/heartjnl-2017-312383

M3 - Article

C2 - 29122931

VL - 104

SP - 594

EP - 599

JO - Heart

JF - Heart

SN - 1355-6037

IS - 7

ER -