BOOK
Approaches to Left Atrial Appendage Exclusion, An Issue of Interventional Cardiology Clinics, E-Book
(2014)
Additional Information
Book Details
Abstract
This issue of Interventional Cardiology Clinics examines approaches to left atrial appendage exclusion. Topics include stroke and bleeding risks in patients with atrial fibrillation, embryology and anatomy, rationale, catheter-based endocardial closure, pericardial access, catheter-based epicardial closure, surgical closure, device and left atrial appendage specific characteristic for successful closure, clinical results, the role of CTA and MRA imaging, imaging with TEE, post-procedural management, and prevention and management of complications.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Approaches to Left Atrial\rAppendage Exclusion | i | ||
| copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Interventional Cardiology Clinics\r | x | ||
| Preface\r | xi | ||
| Stroke and Bleeding Risks in Patients with Atrial Fibrillation | 175 | ||
| Key points | 175 | ||
| Introduction | 175 | ||
| Methods | 176 | ||
| Stroke Risk in Atrial Fibrillation | 176 | ||
| Stroke Risk–Prediction Schemes | 176 | ||
| von Willebrand Factor Levels as a Risk Factor for Stroke | 176 | ||
| AF Burden as a Risk Factor for Stroke | 177 | ||
| Antiplatelet Therapy for Stroke Prevention in AF | 178 | ||
| Warfarin for Stroke Prophylaxis in Patients with AF | 179 | ||
| Novel OACs and the Risk of Stroke in Patients with AF | 180 | ||
| Bleeding Risk | 181 | ||
| Bleeding Risk Definition in Major Clinical Trials | 181 | ||
| Bleeding Risk with Antiplatelet Regimen and Dual Antiplatelet Therapy | 182 | ||
| Bleeding Risk with Warfarin and Newer OACs | 182 | ||
| Bleeding Risk–Prediction Schemes | 183 | ||
| Summary | 186 | ||
| References | 187 | ||
| Embryology and Anatomy of the Left Atrial Appendage | 191 | ||
| Key points | 191 | ||
| Introduction | 191 | ||
| Embryology of the LAA | 191 | ||
| Anatomic features | 192 | ||
| Histology of the LAA | 194 | ||
| Physiologic Function | 194 | ||
| Pathologic changes in the LAA in AF | 194 | ||
| Predictors of thromboembolism | 196 | ||
| Local Factors | 196 | ||
| LAA shape and size | 196 | ||
| LAA dysfunction | 197 | ||
| Role of left ventricular dysfunction in thrombus formation | 197 | ||
| Local Prothrombotic Agents | 198 | ||
| Oxidative stress and free radicals | 198 | ||
| Adhesion molecules and other procoagulants | 198 | ||
| von Willebrand factor | 198 | ||
| Renin angiotensin system | 199 | ||
| Systemic Factors | 199 | ||
| Platelets | 199 | ||
| Procoagulants, growth factors, and cytokines | 199 | ||
| Others | 199 | ||
| Summary | 199 | ||
| References | 199 | ||
| Rationale for Left Atrial Appendage Exclusion | 203 | ||
| Key points | 203 | ||
| Introduction | 203 | ||
| Stroke and AF | 203 | ||
| AF and LAA Thrombus | 204 | ||
| Assessing Stroke Risk | 204 | ||
| Antithrombotic Therapy for Stroke Prevention in Nonvalvular AF | 204 | ||
| Limitations of Antithrombotic Therapy for Stroke Prevention in AF | 205 | ||
| Bleeding | 205 | ||
| Untreated and out-of-target-range patients | 205 | ||
| Alternatives to Warfarin | 206 | ||
| Rationale for LAA Exclusion | 206 | ||
| References | 207 | ||
| Left Atrial Appendage Closure with Transcatheter-Delivered Devices | 209 | ||
| Key points | 209 | ||
| Introduction | 209 | ||
| The oral anticoagulation treatment deficit | 209 | ||
| Emergence of LAA closure | 210 | ||
| LAA Surgical Occlusion and Excision | 210 | ||
| Appriva: PLAATO Device | 210 | ||
| Data-driven LAA closure: the Watchman LAA occluder | 211 | ||
| The Watchman Learning Curve | 213 | ||
| Current Indications for LAA Closure | 214 | ||
| Emerging LAA investigation and technologies | 214 | ||
| Adjunctive Pharmacology | 214 | ||
| AGA Medical/St. Jude Medical: Amplatzer Cardiac Plug | 215 | ||
| Emerging Technologies | 215 | ||
| The Coherex WaveCrest LAA Occluder | 215 | ||
| Occlutech LAA Occluder | 215 | ||
| LifeTech LAA Occluder: LAmbre | 216 | ||
| Cardia Ultrasept LAA Occluder | 216 | ||
| Summary | 216 | ||
| References | 217 | ||
| Catheter-based Epicardial Closure of the Left Atrial Appendage | 219 | ||
| Key points | 219 | ||
| Introduction | 219 | ||
| Epicardial approach | 220 | ||
| Imaging During Procedure | 223 | ||
| Inclusion Criteria | 223 | ||
| Exclusion Criteria | 223 | ||
| Preliminary Studies and Results | 223 | ||
| Additional considerations | 224 | ||
| Epicardial Approach | 225 | ||
| Pericarditis and Pericardial Effusion | 225 | ||
| Thrombus Formation in Patients Taken Off Blood Thinner | 225 | ||
| Incomplete Closure of LAA | 225 | ||
| Laceration of the LAA | 225 | ||
| Effect on Arrhythmia Burden | 225 | ||
| New percutaneous nonsurgical techniques | 225 | ||
| AEGIS | 225 | ||
| EPITEK | 226 | ||
| Summary | 226 | ||
| References | 226 | ||
| Managing the Left Atrial Appendage in the Era of Minimally Invasive Surgery | 229 | ||
| Key points | 229 | ||
| Introduction | 229 | ||
| LAA | 230 | ||
| History of LAA occlusion | 230 | ||
| Surgical techniques for LAA occlusion | 230 | ||
| Results with different surgical techniques | 232 | ||
| Minimally invasive approaches | 233 | ||
| Summary | 236 | ||
| Videos | 236 | ||
| References | 236 | ||
| Device- and LAA-Specific Characteristics for Successful LAA Closure: Tips and Tricks\r | 239 | ||
| Key points | 239 | ||
| Introduction | 239 | ||
| The functional anatomy of the LAA | 239 | ||
| The WATCHMAN device | 240 | ||
| Transseptal Puncture and LAA Access | 241 | ||
| The Working View | 244 | ||
| Device Deployment, Recapture, and Release | 244 | ||
| Difficult LAA Anatomies | 244 | ||
| Summary | 245 | ||
| The AMPLATZER cardiac plug | 245 | ||
| TSP And LAA Access | 245 | ||
| The Working View | 247 | ||
| Device Deployment, Recapture, and Release | 247 | ||
| Difficult LAA Anatomies | 248 | ||
| Summary | 249 | ||
| The COHEREX WaveCrest | 249 | ||
| The LARIAT suture delivery device | 250 | ||
| Role of CT Scan | 250 | ||
| Pericardial Access | 250 | ||
| Endo-FindrWIRZ Positioning | 250 | ||
| Snare Alignment, Deployment, and Removal | 250 | ||
| Summary | 252 | ||
| Managing complications | 252 | ||
| Femoral Vein Access Hemostasis | 252 | ||
| LAA Perforation | 252 | ||
| Air Embolism | 254 | ||
| Incomplete Closure | 254 | ||
| Device Dislodgment and Embolism | 254 | ||
| Summary | 254 | ||
| References | 254 | ||
| Role of Transesophageal Echocardiography in Left Atrial Appendage Device Closure | 255 | ||
| Key points | 255 | ||
| Introduction | 255 | ||
| LAA anatomy | 255 | ||
| Echocardiographic examination of the LAA | 257 | ||
| Doppler characteristics of LAA function | 264 | ||
| Periprocedural guidance in LAA procedures | 270 | ||
| Transseptal Puncture | 270 | ||
| Localization of the Catheter in the LAA | 273 | ||
| Assessment of Pericardial Effusion on Echocardiography | 274 | ||
| Watchman Device Deployment | 274 | ||
| Watchman Improper Positioning | 278 | ||
| Lariat Device Implantation | 278 | ||
| References | 279 | ||
| Pericardial Access for LARIAT Left Atrial Appendage Closure | 281 | ||
| Key points | 281 | ||
| Introduction: nature of the problem | 281 | ||
| Anatomic considerations: location of the LAA within the pericardial sac and relevance of the puncture site | 281 | ||
| Preprocedural planning | 283 | ||
| The anterior pericardial puncture | 283 | ||
| Potential difficulties and complications | 285 | ||
| Adhesions | 285 | ||
| Entry That Is Too Medial or Too Lateral | 286 | ||
| Pleural Puncture | 287 | ||
| Right Ventricular Perforation | 287 | ||
| Additional Complications | 288 | ||
| Summary | 288 | ||
| References | 288 | ||
| Clinical Results with Percutaneous Left Atrial Appendage Occlusion | 291 | ||
| Key points | 291 | ||
| Introduction | 291 | ||
| Background | 291 | ||
| Overall Observations Regarding the LAA Closure Literature | 292 | ||
| Percutaneous Approach: Nonrandomized Trial Findings | 292 | ||
| PLAATO | 294 | ||
| WATCHMAN | 294 | ||
| ACP | 294 | ||
| LARIAT | 294 | ||
| ASAP | 295 | ||
| PROTECT AF | 295 | ||
| Controversy | 297 | ||
| Procedural Complications | 297 | ||
| Future Issues | 298 | ||
| References | 298 | ||
| Prevention and Management of Complications of Left Atrial Appendage Closure Devices | 301 | ||
| Key points | 301 | ||
| Introduction | 301 | ||
| Incidence of complications during transcatheter LAA closure | 302 | ||
| WATCHMAN LAA Occluder | 302 | ||
| Amplatzer Cardiac Plug | 302 | ||
| Transcatheter Ligation of the LAA | 303 | ||
| Strategies to prevent complications | 303 | ||
| Transseptal Puncture | 303 | ||
| Evaluation of the LAA | 304 | ||
| Entry of needle and transseptal sheath into the left atrium | 304 | ||
| Introduction of Equipment into the Left Atrial Appendage | 306 | ||
| LAA occluder delivery sheaths | 306 | ||
| LAA management during the LARIAT procedure | 306 | ||
| Device Embolization | 307 | ||
| Pericardial Access Complications | 307 | ||
| Management strategies | 309 | ||
| Pericardial Effusion | 309 | ||
| Pericardial effusion or tamponade during the LARIAT procedure | 309 | ||
| Autotransfusion | 309 | ||
| Chest Pain | 309 | ||
| Summary | 310 | ||
| References | 310 | ||
| Index | 313 |