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Title of the item:

Left atrial appendage closure after cryoballoon ablation in patients with atrial fibrillation.

Title :
Left atrial appendage closure after cryoballoon ablation in patients with atrial fibrillation.
Authors :
Liu J; Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China. .
Xia Y; Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China.
Zhang H; Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China.
Li X; Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China.
Zhang S; Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China.
Fang P; Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China.
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Transliterated Title :
Verschluss des linken Herzohrs nach Kryoballonablation bei Patienten mit Vorhofflimmern.
Source :
Herz [Herz] 2021 Apr; Vol. 46 (Suppl 1), pp. 82-88. Date of Electronic Publication: 2020 Jan 30.
Publication Type :
Journal Article
Language :
English
Imprint Name(s) :
Publication: Munchen : Urban Und Vogel
Original Publication: München, Urban & Schwarzenberg.
MeSH Terms :
Atrial Appendage*/diagnostic imaging
Atrial Appendage*/surgery
Atrial Fibrillation*/surgery
Cardiac Surgical Procedures*
Catheter Ablation*
Pulmonary Veins*/diagnostic imaging
Pulmonary Veins*/surgery
Female ; Humans ; Male ; Treatment Outcome
References :
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January CT, Wann LS, Calkins H (2019) 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol 74:104–132. (PMID: 10.1016/j.jacc.2019.01.011)
Liu J, Kaufmann J, Kriatselis C (2015) Outcome of cryoballoon ablation for atrial fibrillation. Medium-term follow-up from a single center. Herz 40:125–129. (PMID: 10.1007/s00059-014-4152-8)
Liu J, Kaufmann J, Kriatselis C (2015) Second generation of cryoballoons can improve efficiency of cryoablation for atrial fibrillation. Pacing Clin Electrophysiol 38:129–135. (PMID: 10.1111/pace.12538)
Liu Z, Yu J, Fang PH (2015) Double device left atrial appendage closure with the WATCHMAN. Int J Cardiol 187:281–282. (PMID: 10.1016/j.ijcard.2015.03.289)
Boersma LV, Schmidt B, Betts TR (2016) Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry. Eur Heart J 37:2465–2474. (PMID: 10.1093/eurheartj/ehv730)
Tzikas A, Holmes DR Jr., Gafoor S (2017) Percutaneous left atrial appendage occlusion: the Munich consensus document on definitions, endpoints, and data collection requirements for clinical studies. Europace 19:4–15. (PMID: 27540038)
Liu J, Fang PH, Hou Y (2010) The value of transtelephonic electrocardiogram monitoring system during the “Blanking Period” after ablation of atrial fibrillation. J Electrocardiol 43:667–672. (PMID: 10.1016/j.jelectrocard.2010.06.007)
Tomaselli GF, Mahaffey KW, Cuker A (2017) 2017 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants: a report of the American College of Cardiology task force on expert consensus decision pathways. J Am Coll Cardiol 70:3042–3067. (PMID: 10.1016/j.jacc.2017.09.1085)
Mehran R, Rao SV, Bhatt DL (2011) Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 123:2736–2747. (PMID: 10.1161/CIRCULATIONAHA.110.009449)
Swaans MJ, Post MC, Rensing BJ (2012) Ablation for atrial fibrillation in combination with left atrial appendage closure: first results of a feasibility study. J Am Heart Assoc 1:e2212. (PMID: 10.1161/JAHA.112.002212)
Wintgens L, Romanov A, Phillips K (2018) Combined atrial fibrillation ablation and left atrial appendage closure: long-term follow-up from a large multicentre registry. Europace 20:1783–1789. (PMID: 10.1093/europace/euy025)
Phillips KP, Pokushalov E, Romanov A (2018) Combining Watchman left atrial appendage closure and catheter ablation for atrial fibrillation: multicentre registry results of feasibility and safety during implant and 30 days follow-up. Europace 20:949–955. (PMID: 10.1093/europace/eux183)
Fassini G, Conti S, Moltrasio M (2016) Concomitant cryoballoon ablation and percutaneous closure of left atrial appendage in patients with atrial fibrillation. Europace 18:1705–1710. (PMID: 10.1093/europace/euw007)
Fassini G, Gasperetti A, Italiano G (2019) Cryoballoon pulmonary vein ablation and left atrial appendage closure combined procedure: a long-term follow-up analysis. Heart Rhythm 16:1320–1326. (PMID: 10.1016/j.hrthm.2019.03.022)
Bordignon S, Perrotta L, Furnkranz A (2015) Durable single shot cryoballoon isolation of the left atrial appendage followed by percutaneous left atrial appendage closure. Circ Arrhythm Electrophysiol 8:751–752. (PMID: 10.1161/CIRCEP.115.002885)
Bordignon S, Chen S, Perrotta L (2019) Durability of cryoballoon left atrial appendage isolation: Acute and invasive remapping electrophysiological findings. Pacing Clin Electrophysiol 42:646–654. (PMID: 10.1111/pace.13690)
Contributed Indexing :
Keywords: Atrial flutter; Bleeding; Catheter ablation; Pulmonary vein isolation; Stroke
Local Abstract: [Publisher, German] HINTERGRUND: Die Kryoballonablation (CBA) ist bei Patienten mit medikamentenresistentem symptomatischem Vorhofflimmern („atrial fibrillation“, AF) wirksam. Besteht ein hohes Risiko für einen Schlaganfall (CHA 2 DS 2 -VASc-Score ≥2), so sollte bei solchen Patienten die Antikoagulationstherapie lebenslang fortgeführt werden, auch nach einer erfolgreichen Katheterablation. Die Autoren untersuchten die Sicherheit und Wirksamkeit der gleichzeitigen Anwendung eines CBA-Katheters der 2. Generation für die Pulmonalvenenisolation (PVI) und eines Systems zum Verschluss des linken Herzohrs („left atrial appendage closure“, LAAC) bei Patienten mit AF. [Publisher, German] In die Studie wurden 27 Patienten im Alter von 64,7 ± 6,3 Jahren einbezogen; 74% männlich; 63% paroxysmales AF; 37% persistierendes AF; CHA 2 DS 2 -VASc-Score (kongestive Herzinsuffizienz, Hypertonie, Alter >75 Jahre: 2 Punkte, Diabetes, Schlaganfall/TIA: 2 Punkte, vaskuläre Erkrankung, Alter: 65–74 Jahre, „sex“/Geschlecht: weiblich): 4,8 ± 1,4; HAS-BLED-Score (Hypertonie, abnormale Nierenfunktion, Schlaganfall, Blutung, labile INR-Einstellung, „elderly“/Alter, „drugs“/Medikamente): 3,6 ± 1,3. Anamnestisch gaben 85% der Patienten einen Schlaganfall oder eine TIA (transitorische ischämische Attacke) an, 30% eine Blutung. Bei den Patienten erfolgte eine CBA zur PVI und der Verschluss des linken Herzohrs mit einem LAAC-System. Die Wirksamkeit der CBA war als das Nichtwiederauftreten der Arrhythmie (AF, Vorhofflattern und/oder Vorhoftachkardie ≥30 s) nach einer Stabilisierungsphase („blanking period“) von 90 Tagen definiert. Der Erfolg der LAAC-Intervention wurde anhand der Rate für Schlaganfall, TIA und/oder Blutungen ermittelt. [Publisher, German] Die mittlere Interventionsdauer für CBA und LAAC betrug 80 ± 16 min bzw. 44 ± 12 min. In 100% der Eingriffe wurde eine akute PVI mit der CBA erzielt, und bei 96% der Patienten erfolgte die Platzierung des LAAC-Systems während des Eingriffs. Bei vollständiger Freigabe des LAAC-Systems war nur bei 62% der Patienten (16/26) keine Leckage in der intraprozeduralen transösophagealen Echokardiographie erkennbar. Eine akute Komplikation trat bei 3 Patienten auf: einmal ein Perikarderguss und 2 Fälle mit Parese des N. phrenicus. Im Mittel betrug die Nachbeobachtungsdauer 18 Monate (Spanne: 9–23 Monate), und die AF-Rezidivfreiheit lag bei 74% (20/27). [Publisher, German] Die Kombination von CBA und LAAC in einem Eingriff ist bei Patienten mit nichtvalvulärem AF und hohem Risiko für Schlaganfall, TIA und/oder Blutung praktikabel. Es sind größere randomisierte Langzeitstudien erforderlich, um die Gesamtsicherheit und -wirksamkeit der kombinierten Intervention zu beurteilen.
Entry Date(s) :
Date Created: 20200201 Date Completed: 20210415 Latest Revision: 20210415
Update Code :
20210623
DOI :
10.1007/s00059-019-04880-4
PMID :
32002565
Academic Journal
Background: Cryoballoon ablation (CBA) is effective for patients with drug-refractory symptomatic atrial fibrillation (AF). For patients with a high risk of stroke (CHA 2 DS 2 -VASc score ≥2), life-long oral anticoagulation therapy should be continued even after successful catheter ablation. We investigated the safety and efficacy of concomitant use of a second-generation CBA catheter for pulmonary vein isolation (PVI) and a left atrial appendage closure (LAAC) device in patients with AF.
Methods: We enrolled 27 patients (64.7 ± 6.3 years, 74% male, 63% paroxysmal AF, 37% persistent AF, 4.8 ± 1.4 CHA 2 DS 2 -VASc score, and 3.6 ± 1.3 HAS-BLED score). In total, 85% of the patients had a prior stroke or TIA, and 30% of patients had a clinical history of bleeding. Patients received a CBA for PVI and underwent occlusion of the LAA with an LAAC device. The efficacy of CBA was defined as lack of arrhythmia recurrence (AF, atrial flutter, and/or atrial tachycardia lasting ≥30 s) after a 90-day blanking period. The success of LAAC was determined by the rate of stroke, TIA, and/or bleeding events.
Results: The mean procedural time for CBA and LAAC was 80 ± 16 min and 44 ± 12 min, respectively. Acute PVI by CBA was achieved in 100% of the procedures, and 96% of patients obtained acute LAAC device placement during the procedure. Upon complete release of the LAAC device, only 62% patients (16/26) had no detectable leakage during intraprocedural transesophageal echocardiography. Three patients experienced an acute complication: a pericardial effusion and two phrenic nerve palsy events. Mean follow-up was 18 months (range 9-23 months), and freedom from AF recurrence was 74% (20/27).
Conclusion: The intraprocedural combination of CBA and LAAC is feasible in patients with non-valvular AF with a high risk of stroke, TIA, and/or bleeding. Larger long-term randomized studies are needed to judge the overall safety and efficacy of the combined procedure.

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