|
1
|
Lv J, Wang R, Yang J, You L, Yang C, Zhang Y, Liu Q, Yin L, Liu JT, Xie RQ. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation. Open Med (Wars) 2024; 19:20240951. [PMID: 38623457 PMCID: PMC11017190 DOI: 10.1515/med-2024-0951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
Objective In the present study, we investigated the impact of left atrial appendage closure (LAAC) following catheter ablation (CA) on the left atrial structure and functioning of patients with paroxysmal atrial fibrillation (AF). Methods Patients with paroxysmal AF were enrolled in this single-center prospective cohort study between April 2015 and July 2021; 353 patients received CA alone, while 93 patients received CA in combination with Watchman LAAC. We used age, gender, CHA2DS2-VASc, and HAS-BLED scores as well as other demographic variables to perform propensity score matching. Patients with paroxysmal AF were randomly assigned to the CA combined with Watchman LAAC group (combined treatment group) and the simple CA group, with 89 patients in each group. The left atrial structure, reserve, ventricular diastole, and pump functions and their changes in patients were assessed using routine Doppler echocardiography and 2D speckle tracking echocardiography over the course of a 1-year follow-up. Results At 1-week follow-up, the reserve, ventricular diastole, and pump functions of the left atrium (LA) increased in both groups; these functions were gradually restored at the 1- to 3-month follow-up; they were close to or returned to their pre-operative levels at the 3-month follow-up; and no significant differences were found compared with the pre-operative levels at the 12-month follow-up. In the first 3 months, the reserve (Ƹ, SRs) and pump functions (SRa) in the combined treatment group decreased significantly when compared with the simple CA group, and the differences were statistically significant. Conclusion Patients with paroxysmal AF may experience a short term, partial effect of LAAC on LA reserve and pump functions, which are gradually restored and the effect disappears by 12 months.
Collapse
Affiliation(s)
- Jing Lv
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
- Division of Cardiology, Xingtai People’s Hospital of Hebei Medical University, Xingtai, Hebei, 054000, China
| | - Rui Wang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Jing Yang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Ling You
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Chao Yang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Yan Zhang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Qian Liu
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Lei Yin
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Jin-ting Liu
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Rui-qin Xie
- Division of Cardiology, The Second Hospital of Hebei Medical University, 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei, 050051, China
| |
Collapse
|
|
2
|
Litwinowicz R, Batko J, Rusinek J, Olejek W, Rams D, Kowalewski M, Bartuś K, Burysz M. LARIAT or AtriClip: Complications Profile and Comparison in Patients with Atrial Fibrillations Based on Manufacturer and User Facility Device Experience Database. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2055. [PMID: 38138158 PMCID: PMC10744657 DOI: 10.3390/medicina59122055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Left atrial appendage closure is an alternative treatment to reduce thromboembolism in patients with atrial fibrillation in whom oral anticoagulation (OAC) is contraindicated. The aim of this study was to evaluate the complications profiles of the LARIAT and AtriClip devices and perform a comparison between them based on the MAUDE (Manufacturer and User Facility Device Experience) database. Materials and Methods: The Manufacturer and User Facility Device Experience database was searched on 15 January 2023. For AtriClip, only reports regarding isolated procedures or procedures associated with minimally invasive ablation were included. Adverse effects and causes of death were defined based on the literature on the topic and the causes described in the reports. In total, 63 patients were included in the LARIAT group and 53 patients were included in the AtriClip group. Results: With the LARIAT device, the most common complication without device problems was pericardial effusion (n = 18, 52.9%), whereas this complication was not observed with AtriClip (p < 0.001). Postoperative bleeding was a second complication that occurred significantly more often in the LARIAT group-in 15 (44.1%) cases versus 1 (2.7%) case with AtriClip (p < 0.001). In addition, significant differences were found in the prevalence of stroke (LARIAT n = 0 vs. AtriClip n = 7, 18.9%, p = 0.012) and thrombus (LARIAT n = 2, 5.9% vs. n = 11, 29.7%, p = 0.013). Conclusions: Each type of left atrial appendage closure procedure is associated with device-specific requirements and complications that, if known, can be avoided.
Collapse
Affiliation(s)
- Radosław Litwinowicz
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Department of Cardiac Surgery, Regional Specialist Hospital, 86-300 Grudziądz, Poland
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, 85-094 Bydgoszcz, Poland
| | - Jakub Batko
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, 85-094 Bydgoszcz, Poland
| | - Jakub Rusinek
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Wojciech Olejek
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, 85-094 Bydgoszcz, Poland
| | - Daniel Rams
- CAROL—Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, 85-094 Bydgoszcz, Poland
| | - Mariusz Kowalewski
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, 85-094 Bydgoszcz, Poland
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137 Str., 02-507 Warsaw, Poland
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), 6229 HX Maastricht, The Netherlands
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Marian Burysz
- Department of Cardiac Surgery, Regional Specialist Hospital, 86-300 Grudziądz, Poland
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, 85-094 Bydgoszcz, Poland
| |
Collapse
|
|
3
|
Yang L, Chung MK. Lifestyle changes in atrial fibrillation management and intervention. J Cardiovasc Electrophysiol 2023; 34:2163-2178. [PMID: 36598428 PMCID: PMC10318120 DOI: 10.1111/jce.15803] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/13/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias in adults, and its continued rise in the United States is complicated by the increased incidence and prevalence of several AF risk factors, such as obesity, physical inactivity, hypertension, obstructive sleep apnea, diabetes mellitus, coronary artery disease, and alcohol, tobacco, or caffeine use. Lifestyle and risk factor modification has been proposed as an additional pillar of AF therapy, added to rhythm control, rate control, and anticoagulation, to reduce AF burden and risk. Although emerging evidence largely supports the integration of lifestyle and risk factor management in clinical practice, randomized clinical trials investigating the long-term sustainability and reproducibility of these benefits remain sparse. The purpose of this review is to discuss potentially reversible risk factors on AF, share evidence for the impact on AF by modification of these risk factors, and then provide an overview of the effects of reversing or managing these risk factors on the success of various AF management strategies, such as antithrombotic, rate control, and rhythm control therapies.
Collapse
Affiliation(s)
- Lucy Yang
- The Departments of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, and Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mina K Chung
- The Departments of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, and Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| |
Collapse
|
|
4
|
Leopoulou M, Theofilis P, Kordalis A, Papageorgiou N, Sagris M, Oikonomou E, Tousoulis D. Diabetes mellitus and atrial fibrillation-from pathophysiology to treatment. World J Diabetes 2023; 14:512-527. [PMID: 37273256 PMCID: PMC10236990 DOI: 10.4239/wjd.v14.i5.512] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/21/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a leading risk factor for cardiovascular complications around the globe and one of the most common medical conditions. Atrial fibrillation (AF) is the most common supraventricular arrhythmia, with a rapidly increasing prevalence. T2DM has been closely associated with the risk of AF development, identified as an independent risk factor. Regarding cardio-vascular complications, both AF and T2DM have been linked with high mortality. The underlying pathophysiology has not been fully determined yet; however, it is multifactorial, including structural, electrical, and autonomic pathways. Novel therapies include pharmaceutical agents in sodium-glucose cotransporter-2 inhibitors, as well as antiarrhythmic strategies, such as cardioversion and ablation. Of interest, glucose-lowering therapies may affect the prevalence of AF. This review presents the current evidence regarding the connection between the two entities, the pathophysiological pathways that link them, and the therapeutic options that exist.
Collapse
Affiliation(s)
- Marianna Leopoulou
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Panagiotis Theofilis
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Athanasios Kordalis
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Nikolaos Papageorgiou
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Marios Sagris
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Evangelos Oikonomou
- 3rd Cardiology Clinic, ‘Sotiria’ Chest Diseases Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| |
Collapse
|
|
5
|
Litwinowicz R, Natorska J, Zabczyk M, Kapelak B, Lakkireddy D, Vuddanda V, Bartus K. Changes in fibrinolytic activity and coagulation factors after epicardial left atrial appendage closure in patients with atrial fibrillation. J Thorac Dis 2022; 14:4226-4235. [PMID: 36524072 PMCID: PMC9745526 DOI: 10.21037/jtd-21-1093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/19/2022] [Indexed: 10/29/2023]
Abstract
BACKGROUND The left atrial appendage (LAA) is known to be the primary source of thrombus formation in atrial fibrillation (AF). We investigate whether epicardial LAA occlusion (LAAO) from the cardiovascular system has an effect on coagulation and prothrombotic status in AF. METHODS Twenty-two patients with nonvalvular AF, who were not currently receiving oral anticoagulation (OAC) therapy, participated in a single-center prospective study. We measured fibrinogen and plasminogen levels along with plasma fibrin clot permeability, clot lysis time (CLT) and endogenous thrombin potential (ETP) before the LAAO procedure, at discharge and 1 month afterward. RESULTS One month after the LAAO procedure, plasma fibrin clot permeability improved by 39.3% as measured by clots prepared from peripheral blood (P=0.019) and also after adjustment for fibrinogen (P=0.027). Higher plasma fibrin clot permeability was associated with improved clot susceptibility to lysis (r=-0.67, P=0.013). CLT was reduced by 10.3% (P=0.0020), plasminogen activator inhibitor-1 antigen levels were reduced by 52% (P=0.023) and plasminogen activity was increased by 8.9% (P=0.0077). A trend toward decreased thrombin generation, reflected by a decreased ETP and peak thrombin generated was also observed 1 month after LAAO procedure (P=0.072 and P=0.087, respectively). No differences were observed in tissue-type plasminogen activator and thrombin-activatable fibrinolysis inhibitor plasma levels (both P>0.05). CONCLUSIONS Obtained results seem to confirm that LAA plays a key role in thrombogenesis. Elimination of LAA from the circulatory system may improve fibrin clot permeability and susceptibility to fibrinolysis in peripheral blood.
Collapse
Affiliation(s)
- Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Natorska
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michal Zabczyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Dhanunjaya Lakkireddy
- The Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS, USA
| | | | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
|
6
|
Batko J, Rams D, Filip G, Bartoszcze A, Kapelak B, Bartuś K, Litwinowicz R. Left Atrial Appendage Morphology and Course of the Circumflex Artery: Anatomical Implications for Left Atrial Appendage Occlusion Procedures. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:424-429. [PMID: 36254406 DOI: 10.1177/15569845221128569] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the anatomic topography of the circumflex artery (Cx) and left atrial appendage (LAA) and to determine the safety zones for epicardial LAA closure and LAA occlusion procedures. METHODS The left coronary artery was segmented and visualized from 116 computed tomography angiography scans. Four points were located on the Cx portion periappendicularly, starting from the entry point. The landing zone plane was defined as parallel to the LAA orifice at the level of the beginning of the periappendicular course of the Cx, and the plane of the neck bend was located at the end of the LAA neck. A distance smaller than 2 mm was considered a dangerous distance. RESULTS The distance between the Cx and the LAA landing zone was 4.3 ± 2 mm. The distance between the Cx and the LAA neck bend was 5.1 ± 2.2 mm. The distance between the Cx and the LAA bottom surface was 5.8 ± 2.9 mm. In 38.8% of patients, at least 1 distance between Cx and LAA was smaller than 2 mm in at least 1 dimension. These distances occurred in 30.2% of the LAA landing zone dimensions, 19.8% of LAA neck bend dimensions, and 11.2% of the LAA bottom surface distances. CONCLUSIONS The study showed that most dangerous distances (30.2%) occurred in the LAA landing zone dimension. The data showed that landing zones more distal from the orifice of the LAA are safer in terms of Cx damage. Therefore, LAA closure should always be performed with caution, to avoid iatrogenic complications.
Collapse
Affiliation(s)
- Jakub Batko
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, CAROL-Cardiothoracic Anatomy Research Operative Lab, Krakow, Poland
| | - Daniel Rams
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, CAROL-Cardiothoracic Anatomy Research Operative Lab, Krakow, Poland
| | - Grzegorz Filip
- Krakow Specialist Hospital named after John Paul II, Poland
| | | | - Bogusław Kapelak
- Krakow Specialist Hospital named after John Paul II, Poland.,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Bartuś
- Krakow Specialist Hospital named after John Paul II, Poland.,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Radosław Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, CAROL-Cardiothoracic Anatomy Research Operative Lab, Krakow, Poland.,Krakow Specialist Hospital named after John Paul II, Poland.,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
|
7
|
Bartus K, Elbey MA, Kanuri SH, Lee R, Litwinowicz R, Natorska J, Zabczyk M, Bartus M, Kapelak B, Malecki MT, Lakkireddy D. Metabolic Effects of the Left Atrial Appendage Exclusion (THE HEART HORMONE STUDY). J Cardiovasc Electrophysiol 2022; 33:2064-2071. [PMID: 35771566 DOI: 10.1111/jce.15604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/07/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The effect of epicardial LAA occlusion therapy on lipid and glucose metabolism in AF patients over the long term follow up is unclear. METHODS In a single-center prospective observational study, 60 patients with longstanding persistent AF with cardiovascular risk factors had undergone an epicardial exclusion procedure. Anthropometric parameters and glucose, glycated hemoglobin (HbA1c), insulin, leptin, adiponectin, free fatty acids, beta-hydroxybutyrate, and total cholesterol levels were evaluated on fasting at baseline before the procedure and compared with levels at 24 hours, 7 days, 1 month, 3 months, 6 months, and 24 months follow the procedure. RESULTS The mean age of the patients was 67.5 ± 8.1. Insulin levels significantly increased at 7 days, 1 month, 3 months, 6 months, 12 months, and 24 months follow-up. The leptin levels showed a significant increase in 6 months, 12 months, and 24 months when compared to baseline. Whereas the adiponectin levels showed a significant decrease at 3 months, 6 months, 12 months, and 24 months when compared to baseline levels. In patients with the epicardial procedure, when compared to baseline, glucose, glycated hemoglobin, total cholesterol, and beta-hydroxybutyrate levels did not show any significant changes at baseline and 24 months follow up. CONCLUSION The epicardial exclusion ligation in AF patients was associated with significant changes in insulin, leptin, and adiponectin over long follow up. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, Medical College, John Paul Hospital, Krakow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Mehmet A Elbey
- Cardiology EP Clinic Fellow, Kansas City Heart Rhythm Institute (KCHRI), Overland Park, KS, USA
| | - Sri Harsha Kanuri
- Cardiology EP Clinic Fellow, Kansas City Heart Rhythm Institute (KCHRI), Overland Park, KS, USA
| | - Randall Lee
- Department of Cardiac Electrophysiology, University of California San Francisco, USA
| | - Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, Medical College, John Paul Hospital, Krakow, Poland
| | - Joanna Natorska
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michal Zabczyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Bartus
- Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, Medical College, John Paul Hospital, Krakow, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Medical College, Jagiellonian University, Krakow, Poland
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA.,University of Missouri - Columbia, USA
| |
Collapse
|
|
8
|
Yosefy O, Sharon B, Yagil C, Shlapoberski M, Livoff A, Novitski I, Beeri R, Yagil Y, Yosefy C. Diabetes induces remodeling of the left atrial appendage independently of atrial fibrillation in a rodent model of type-2 diabetes. Cardiovasc Diabetol 2021; 20:149. [PMID: 34301258 PMCID: PMC8306366 DOI: 10.1186/s12933-021-01347-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/15/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diabetic patients have an increased predisposition to thromboembolic events, in most cases originating from thrombi in the left atrial appendage (LAA). Remodeling of the LAA, which predisposes to thrombi formation, has been previously described in diabetic patients with atrial fibrillation, but whether remodeling of the LAA occurs in diabetics also in the absence of atrial fibrillation is unknown. To investigate the contribution of diabetes, as opposed to atrial fibrillation, to remodeling of the LAA, we went from humans to the animal model. METHODS We studied by echocardiography the structure and function of the heart over multiple time points during the evolution of diabetes in the Cohen diabetic sensitive rat (CDs/y) provided diabetogenic diet over a period of 4 months; CDs/y provided regular diet and the Cohen diabetic resistant (CDr/y), which do not develop diabetes, served as controls. All animals were in sinus rhythm throughout the study period. RESULTS Compared to controls, CDs/y developed during the evolution of diabetes a greater heart mass, larger left atrial diameter, wider LAA orifice, increased LAA depth, greater end-diastolic and end-systolic diameter, and lower E/A ratio-all indicative of remodeling of the LAA and left atrium (LA), as well as the development of left ventricular diastolic dysfunction. To investigate the pathophysiology involved, we studied the histology of the hearts at the end of the study. We found in diabetic CDs/y, but not in any of the other groups, abundance of glycogen granules in the atrial appendages , atria and ventricles, which may be of significance as glycogen granules have previously been associated with cell and organ dysfunction in the diabetic heart. CONCLUSIONS We conclude that our rodent model of diabetes, which was in sinus rhythm, reproduced structural and functional alterations previously observed in hearts of human diabetics with atrial fibrillation. Remodeling of the LAA and of the LA in our model was unrelated to atrial fibrillation and associated with accumulation of glycogen granules. We suggest that myocardial accumulation of glycogen granules is related to the development of diabetes and may play a pathophysiological role in remodeling of the LAA and LA, which predisposes to atrial fibrillation, thromboembolic events and left ventricular diastolic dysfunction in the diabetic heart.
Collapse
Affiliation(s)
- Or Yosefy
- Department of Cardiology, Barzilai University Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel
| | - Barucha Sharon
- Department of Cardiology, Barzilai University Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Chana Yagil
- Laboratory for Molecular Medicine and Israeli Rat Genome Center, Barzilai University Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Mark Shlapoberski
- Department of Pathology, Barzilai University Medical Center, Ashkelon, Israel
| | - Alejandro Livoff
- Department of Pathology, Barzilai University Medical Center, Ashkelon, Israel
| | - Ilana Novitski
- Department of Pathology, Barzilai University Medical Center, Ashkelon, Israel
| | - Ronen Beeri
- Diagnostic Cardiology Unit, Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yoram Yagil
- Laboratory for Molecular Medicine and Israeli Rat Genome Center, Barzilai University Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
| | - Chaim Yosefy
- Department of Cardiology, Barzilai University Medical Center, 2 Hahistadrut Street, 78278, Ashkelon, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
| |
Collapse
|
|
9
|
Litwinowicz R, Burysz M, Mazur P, Kapelak B, Bartus M, Lakkireddy D, Lee RJ, Malec‐Litwinowicz M, Bartus K. Endocardial versus epicardial left atrial appendage exclusion for stroke prevention in patients with atrial fibrillation: Midterm follow‐up. J Cardiovasc Electrophysiol 2020; 32:93-101. [DOI: 10.1111/jce.14802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/28/2020] [Accepted: 10/09/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College John Paul II Hospital Krakow Poland
| | - Marian Burysz
- Department of Cardiac Surgery Regional Specialist Hospital Grudziadz Poland
| | - Piotr Mazur
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College John Paul II Hospital Krakow Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College John Paul II Hospital Krakow Poland
| | - Magdalena Bartus
- Departament of Pharmacology Jagiellonian University Medical College Krakow Poland
| | - Dhanunjaya Lakkireddy
- The Kansas City Heart Rhythm Institute & Research Foundation Overland Park Kansas USA
| | - Randall J. Lee
- Department of Medicine and Cardiovascular Research Institute University of California San Francisco California USA
| | | | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College John Paul II Hospital Krakow Poland
| |
Collapse
|
|
10
|
Litwinowicz R, Mazur P, Burysz M, Filip G, Wasilewski G, Kapelak B, Bartus K. Why should cardiac surgeons occlude the left atrial appendage percutaneously? J Card Surg 2020; 35:3458-3464. [PMID: 32939852 DOI: 10.1111/jocs.14991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Percutaneous left atrial appendage (LAA) occlusion (LAAO) is a procedure dominated by cardiologists. The aim of our study was to present the results of percutaneous LAAO performed solely by cardiac surgeons. METHODS Two hundred twenty-three consecutive patients with nonvalvular atrial fibrillation underwent percutaneous LAAO in two cardiac surgery sites. In the first center, all 84 LAAO procedures were performed with the endocardial LAA occluders: 60 cases with the Amulet and 24 cases with the LAmbre. In the second center, all 139 LAAO procedures were performed with the LARIAT epicardial device. RESULTS The mean CHA2 DS2 -VASc-score was 3.7 ± 1.8 points, and mean HAS-BLED score was 3.6 ± 1.2 points. The procedure was successful in 97.3% of cases. Procedural or device-related adverse events were noted in 4.4% (n = 10) of cases: one periprocedural cardiac arrest, one aortic injury, one gastrointestinal bleeding, three cases of vascular access complications, and four cardiac tamponades. After a follow-up of 40.3 ± 17.3 months, 78.4% of patients were alive, with the annual mortality rate of 5.3%. Compared to the predicted risk, the observed incidence of thromboembolism was lower by 71%, and the bleeding incidence was lower by 69%. CONCLUSIONS Percutaneous LAAO procedures can be safely performed by cardiac surgeons, with no cardiological assistance. LAAO done by surgeons is safe and effective, and periprocedural and long-term outcomes are excellent. Cardiac surgeons should be trained in both types of LAAO: endocardial and epicardial.
Collapse
Affiliation(s)
- Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland.,Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Piotr Mazur
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland.,Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Marian Burysz
- Department of Cardiac Surgery, Regional Specialist Hospital, Grudziadz, Poland
| | - Grzegorz Filip
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Grzegorz Wasilewski
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland.,Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland.,Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| |
Collapse
|
|
11
|
Long-term effect of anticoagulation following left atrial appendage occlusion with the LARIAT device in patients with nonvalvular atrial fibrillation: impact on thromboembolism, bleeding and mortality. Real life data. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:89-96. [PMID: 32368241 PMCID: PMC7189129 DOI: 10.5114/aic.2020.93916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/16/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Indications for left atrial appendage occlusion (LAAO) are varied and patients require individual management strategies. However, currently no guidelines exist for postprocedure oral anticoagulation (OAC) after an LAAO procedure. Aim To evaluate the effect of OAC on thromboembolism, bleeding and mortality following the LAAO procedure for patients with AF. Material and methods One hundred and thirty-nine consecutive patients with nonvalvular atrial fibrillation (NVAF) who underwent LAAO with the LARIAT device were followed for at least 40 months. Decisions about OAC and its modifications were individualized based on clinical presentation, patient and physician preferences. Results Following LAAO, 52 (41%) patients did not receive OAC (No-OAC group) and 75 (59%) patients received OAC (OAC group), without any intergroup differences in CHADS2, CHA2DS2-VASc score or other thromboembolic risk factors. The median HAS-BLED score was higher in the OAC-group (median 3 (3-4) vs. 3 (2-4), p = 0.014). During a median follow-up time of 51 (43-57) vs. 55 (48-59) months in the No-OAC group and in the OAC group (p = 0.19) there were no significant differences between groups in ischemic stroke/TIA, 0 (0%) vs. 2 (2.7%), other thromboembolic events, 0 (0%) vs. 1 (1.3%), life-threatening, disabling or major events, 2 (3.7%) vs. 2 (2.7%), or annual mortality rate, 1.9% vs. 0.9%, respectively. Conclusions There is no need for OAC after the LAAO procedure. Omitting OAC after an LAAO procedure in AF patients: (1) has similar stroke prevention rates as patients on OAC, (2) has similar bleeding prevention rates as patients on OAC, (3) has similar safety endpoints and long-term efficacy as patients on OAC.
Collapse
|
|
12
|
Bartus K, Litwinowicz R, Natorska J, Zabczyk M, Undas A, Kapelak B, Lakkireddy D, Lee RJ. Coagulation factors and fibrinolytic activity in the left atrial appendage and other heart chambers in patients with atrial fibrillation: is there a local intracardiac prothrombotic state? (HEART-CLOT study). Int J Cardiol 2020; 301:103-107. [DOI: 10.1016/j.ijcard.2019.09.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
|
|
13
|
Brzeziński M, Sejda A, Pęksa R, Pawlak M, Bury K, Adamiak Z, Kowalik M, Jagielak D, Bartus K, Hołda MK, Litwinowicz R, Rogowski J. Evaluation of Local Tissue Reaction After the Application of a 3D Printed Novel Holdfast Device for Left Atrial Appendage Exclusion. Ann Biomed Eng 2019; 48:133-143. [PMID: 31309369 PMCID: PMC6928093 DOI: 10.1007/s10439-019-02320-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/04/2019] [Indexed: 12/16/2022]
Abstract
The left atrial appendage (LAA) is a small, finger-like extension of the left atrium and its exclusion is used as a treatment strategy to prevent ischemic stroke. Existing holdfast devices may damage the tissue, are unisized and not adjustable. A novel holdfast device for LAA exclusion devoid of these shortcomings was designed and 3D-printed using the Selective Laser Sintering (SLS) technology with polyamide powder and tested it on animal model. We selected the SLS 3D printing technology due to its wid14e availability and low production costs which could provide on-site 3D printing for specific patient. The purpose of this study was to evaluate the biocompatibility of the reported holdfast device and compare the histological results obtained for local tissue reactions to those obtained for an established grafting material. Thirty swine subdivided into two groups were examined. The LAA exclusion device was implanted and was either coated with a polyester vascular implant or not coated at all and the histological response to the device’s presence was evaluated which is a standard approach to test the device biocompatibility. In all cases, complete occlusion was seen without any pathological findings during the incubation time. In both groups, the surface of the atrium under a holdfast device was smooth and shiny and had no clots. The foreign body reaction of the LAA holdfast device made of polyamide powder was insignificantly lower compared to the polyester graft. Thus, it fulfils the parameters of biocompatibility at the highest degree, and makes it suitable material for the manufacturing of LAA holdfast devices.
Collapse
Affiliation(s)
- Maciej Brzeziński
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Aleksandra Sejda
- Department of Pathomorphology, Medical University of Gdansk, Gdańsk, Poland
| | - Rafał Pęksa
- Department of Pathomorphology, Medical University of Gdansk, Gdańsk, Poland
| | - Maciej Pawlak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Kamil Bury
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Zbigniew Adamiak
- Department of Surgery and Roentgenology, Faculty of Veterinary Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Maciej Kowalik
- Department of Anesthesiology and Intensive Care, Medical University of Gdansk, Gdańsk, Poland
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Kraków, Poland.
| | - Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | - Jan Rogowski
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| |
Collapse
|
|
14
|
Percutaneous left atrial appendage closure using the LAmbre device. First clinical results in Poland. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:251-254. [PMID: 31497060 PMCID: PMC6727234 DOI: 10.5114/aic.2019.86019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/28/2019] [Indexed: 11/17/2022] Open
|
|
15
|
Litwinowicz R, Bartus M, Kapelak B, Suwalski P, Lakkireddy D, Lee RJ, Bartus K. Reduction in risk of stroke and bleeding after left atrial appendage closure with LARIAT device in patients with increased risk of stroke and bleeding: Long term results. Catheter Cardiovasc Interv 2019; 94:837-842. [DOI: 10.1002/ccd.28187] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/19/2019] [Accepted: 02/28/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and TransplantologyJagiellonian University, John Paul II Hospital Poland
| | | | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and TransplantologyJagiellonian University, John Paul II Hospital Poland
| | - Piotr Suwalski
- Department of Cardiac SurgeryCentral Clinical Hospital of Ministry of Interior Warsaw Poland
| | - Dhanunjaya Lakkireddy
- The Kansas City Heart Rhythm InstituteOverland Park Regional Hospital, University of Kansas Overland Park Kansas
| | - Randall J. Lee
- Department of Medicine, Division of Cardiac ElectrophysiologyUniversity of California San Francisco San Francisco California
- Cardiovascular Research Institute, Institute for Regeneration MedicineUniversity of California San Francisco San Francisco California
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and TransplantologyJagiellonian University, John Paul II Hospital Poland
| |
Collapse
|
|
16
|
Menne MF, Schrickel JW, Nickenig G, Al‐Kassou B, Nelles D, Schmitz‐Rode T, Steinseifer U, De Backer O, Sedaghat A. Mechanical properties of currently available left atrial appendage occlusion devices: A bench‐testing analysis. Artif Organs 2019; 43:656-665. [DOI: 10.1111/aor.13414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Matthias F. Menne
- Institute of Applied Medical Engineering Helmholtz Institute, RWTH Aachen University Aachen Germany
| | - Jan W. Schrickel
- Med. Klinik und Poliklinik II—Kardiologie, Universitätsklinikum Bonn, Rheinische Friedrich‐Wilhelms‐Universität Bonn Bonn Germany
| | - Georg Nickenig
- Med. Klinik und Poliklinik II—Kardiologie, Universitätsklinikum Bonn, Rheinische Friedrich‐Wilhelms‐Universität Bonn Bonn Germany
| | - Baravan Al‐Kassou
- Med. Klinik und Poliklinik II—Kardiologie, Universitätsklinikum Bonn, Rheinische Friedrich‐Wilhelms‐Universität Bonn Bonn Germany
| | - Dominik Nelles
- Med. Klinik und Poliklinik II—Kardiologie, Universitätsklinikum Bonn, Rheinische Friedrich‐Wilhelms‐Universität Bonn Bonn Germany
| | - Thomas Schmitz‐Rode
- Institute of Applied Medical Engineering Helmholtz Institute, RWTH Aachen University Aachen Germany
| | - Ulrich Steinseifer
- Institute of Applied Medical Engineering Helmholtz Institute, RWTH Aachen University Aachen Germany
- Monash Institute of Medical Engineering and Department of Mechanical and Aerospace Engineering Monash University Melbourne Australia
| | | | - Alexander Sedaghat
- Med. Klinik und Poliklinik II—Kardiologie, Universitätsklinikum Bonn, Rheinische Friedrich‐Wilhelms‐Universität Bonn Bonn Germany
| |
Collapse
|
|
17
|
Coronary artery bypass grafting after left atrial appendage ligation - is anti-inflammatory treatment after LARIAT effective? ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 14:438-439. [PMID: 30603037 PMCID: PMC6309851 DOI: 10.5114/aic.2018.79877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/18/2018] [Indexed: 11/17/2022] Open
|
|
18
|
Rapid left atrial appendage thrombus formation before suture ligation with LARIAT. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:435-437. [PMID: 30603036 PMCID: PMC6309844 DOI: 10.5114/aic.2018.79876] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/18/2018] [Indexed: 12/04/2022] Open
|