Cardiology News /Recent Literature Review / Third Quarter 2013

Abstract

HCS Meeting: Athens, 10-12/10/2013

 TCT Meeting: San Francisco, 28/10-1/11/13

 AHA 2013: Dallas, 16-20/11/13  

 ACC 2014: Washington, DC, 29-31/3/2014

 Athens Cardiology Update 2014: Athens (Crown Plaza Hotel), 10-12/4/2014

 HRS Meeting: San Francisco, 7-10/5/2014

 EuroPCR: Paris, 20-23/5/2014

 CardioStim 2014: Nice, 18-21/6/2014

 Percutaneous Left Atrial Appendage Closure May be a Therapeutic Alternative in Patients with Atrial Fibrillation (AF) and Absolute Contraindications to Anticoagulation Therapy

Left atrial appendage closure (LAAC) with the AMPLATZER Cardiac Plug (ACP) was successfully performed in 51 of 52 (98%) patients (aged 74+8 years) with AF and absolute contraindications to anticoagulation therapy. Most patients received dual-antiplatelet therapy after the procedure for 1-3 months and single antiplatelet therapy thereafter. Main complications were device embolization (1.9%) and pericardial effusion (1.9%), with no cases of periprocedural stroke. At follow-up (20+5 months), death rate was 5.8%, stroke 1.9%, systemic embolism 0%, pericardial effusion 1.9%, and major bleeding 1.9%. The presence of mild peridevice leak was observed in 16.2% of patients at the 6-month follow-up as evaluated by transesophageal echo. There were no cases of device thrombosis. The authors concluded that in patients with nonvalvular AF at high risk of cardioembolic events and absolute contraindications to anticoagulation, LAAC using the ACP device followed by dual-/single-antiplatelet therapy was associated with a low rate of embolic and bleeding events and no device thrombosis at short and midterm follow-up (Urena M et al, J Am Coll Cardiol 2013;62:96–102).

 Preliminary Favorable Experience With Percutaneous Left Atrial Appendage Suture Ligation Using the LARIAT Device in Patients With Atrial Fibrillation

Percutaneous ligation of the left atrial appendage (LAA) with the LARIAT device (a snare with a pre-tied suture guided epicardially over the LAA) was success-fully performed in 85 of 89 (96%) patients with complete closure achieved in 81 patients, while 4 had a <2-3-mm residual LAA leak. There were 3 complications (during pericardial access, n=2; & transseptal catheterization, n=1). Adverse events included severe pericarditis post-operatively (n=2), late pericardial effusion (n=1), sudden death (n=2), & late strokes (n=2). At 1 (81 of 85) & 3 months (77 of 81) post-ligation, 95% of the patients had complete LAA closure by transesophageal echo (TEE). Of the 65 patients undergoing 1-year TEE, there was 98% complete LAA closure, including patients with previous leaks. The authors concluded that LAA closure with the LARIAT device can be performed effectively with acceptably low complication rate (Bartus et al, J Am Coll Cardiol 2013;62:108–118)... (excerpt)