BROADCASTS.com

CardioNerds Amit Goyal, Dr. Colin Blumenthal, Dr. Kelly Arps and Dr. Justice Oranefo discuss mechanical stroke prevention in atrial fibrillation with Dr. Christopher Ellis, cardiac electrophysiology lab director and director of the left atrial appendage closure program at Vanderbilt University. There has been a significant increase in the number of patients undergoing left atrial appendage occlusion (LAAO). This trend is expected to continue with current and upcoming clinical data on this topic. In this episode we dive into the rationale behind LAAO and explore several historical facts. We then proceed to the current state of practice including currently available options, appropriate indications, post op care, and potential complications. Notes were drafted by Dr. Justice Oranefo. Audio editing by\xa0CardioNerds Academy Intern,\xa0student doctor Chelsea Amo Tweneboah.\n\n\n\nThis CardioNerds Atrial Fibrillation series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs,\xa0Dr. Kelly Arps\xa0and\xa0Dr. Colin Blumenthal.\n\n\n\nThis series is supported by an educational grant from the Bristol Myers Squibb and Pfizer Alliance. All CardioNerds content is planned, produced, and reviewed solely by CardioNerds.\n\n\n\nWe have collaborated with VCU Health to provide CME. Claim free CME here!\n\n\n\nDisclosures: Dr. Ellis discloses grant or research support from Boston Scientific, Abbott-St Jude, advisor for Atricure and Medtronic.\n\n\n\n\n\n\n\n\n\nCardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll\n\n\n\n\n\nCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!\n\n\n\n\n\n\n\n\n\nPearls and Quotes - Atrial Fibrillation: Mechanical Stroke Prevention in Atrial fibrillation \n\n\n\n\nSurgical or catheter based left atrial appendage occlusion results in mechanical exclusion of the left atrial appendage, which is the most common source of thrombus leading to embolic events in patients with non-rheumatic atrial fibrillation.\n\n\n\nSurgical LAAO should be considered in patients with atrial fibrillation and CHA2DS2VASC score \u2265 2 undergoing cardiac surgery for other indications.\n\n\n\nEndocardial LAAO devices such as WATCHMAN FLX and AMULET are approved for stroke prevention in patients with atrial fibrillation with a CHA2DS2VASC score \u2265 2 and have an appropriate reason to seek a non-drug alternative to anticoagulation therapy.\n\n\n\nAppropriate patient selection and post-operative anticoagulation and imaging strategy are crucial for prevention and management of complications related to LAAO.\n\n\n\n\nNotes - Atrial Fibrillation: Mechanical Stroke Prevention in Atrial fibrillation \n\n\n\nWhat are the types of LAAO device?\n\n\n\nLeft atrial appendage occlusion devices can be divided into epicardial closure and endocardial closure.\n\n\n\nEpicardial techniques/devices include surgical ligation, Atriclip, and Lariat. These techniques require pericardial access (either by open thoracotomy or thoracoscopic access). The goals are complete exclusion and ischemic necrosis of the LAA.\n\n\n\nLARIAT device\n\n\n\n\n\n\n\nAtriclip device\n\n\n\n\n\n\n\nEndocardial techniques include WATCHMAN FLX and AMULET devices. These techniques require the use of nitinol-based devices which are delivered into the LAA via a transeptal approach. These devices become endothelialized over time resulting in occlusion of the LAA.\n\n\n\nAMULET device\n\n\n\n\n\n\n\nWATCHMAN FLX\n\n\n\n\n\n\n\nWho is the ideal candidate for surgical LAAO?\n\n\n\nSeveral studies have evaluated the efficacy of surgical LAA occlusion. The most prominent being the LAOS III trial which randomized 4770 patients with atrial fibrillation and CHA2DS2VASC \u2265 2 undergoing cardiac surgery for other reasons to surgical LAAO vs no LAAO (3,4). The primary outcome of ischemic stroke or systemic embolization occurred in 4.8% of patients in the LAAO group vs 7% of patients in control group over an average ...