The interventional left atrial appendage closure (LAAC) is an emerging alternative to oral antico... more The interventional left atrial appendage closure (LAAC) is an emerging alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) in concomitance with a contraindication for standard OAC. This subanalysis of the LAARGE registry aims to investigate on differences between different LAA morphologies in a real-world setting. This prospective, multicenter, observational registry included 562 patients from 37 centers with ineligibility for long-term OAC between April 2014 and January 2016. Baseline characteristics, indications, procedural data and complications were registered according to each LAA morphology (i.e., chicken wing, cauliflower, windsock, cactus and atypical morphologies). Implantation success was high across the 4 typical anatomies (≥ 98%, p=n.s.), only atypical anatomies exhibited a lower success rate (94%). The cactus shaped LAA was linked to a trend towards a shorter and the atypical LAAs to a prolonged fluoroscopy time (p=0.058 and p=0.009 versus the overall mean, respectively). Periprocedural and intra-hospital complications were generally rare, with no differences between the different morphologies (p=n.s.). Procedural success as well as complication rates of LAAC were not different amongst the 4 typical LAA morphologies. Only in patients with atypical LAA morphologies a lower implantation success was obvious.
Catheterization and Cardiovascular Interventions, Mar 8, 2011
In most patients with atrial fibrillation (AF) and stroke, there is thrombotic embolization from ... more In most patients with atrial fibrillation (AF) and stroke, there is thrombotic embolization from the left atrial appendage (LAA). Percutaneous closure of the LAA is a novel alternative for the treatment of patients with AF at a high risk of stroke, in whom long-term anticoagulation therapy is not possible or not desired. This study details the initial experience with the Amplatzer Cardiac Plug (ACP) in humans. Investigator-initiated retrospective preregistry data collection to evaluate procedural feasibility and safety up to 24 hr after implantation of the ACP, a nitinol device designed for percutaneous trans-septal implantation in LAA of patients with paroxysmal, permanent, or persistent AF. In 137 of 143 patients, LAA occlusion was attempted, and successfully performed in 132 (96%). There were serious complications in 10 (7.0%) patients (three patients with ischemic stroke; two patients experienced device embolization, both percutaneously recaptured; and five patients with clinically significant pericardial effusions). Minor complications were insignificant pericardial effusions in four, transient myocardial ischemia in two, and loss of the implant in the venous system in one patient. The implantation of the ACP device is a feasible method for percutaneous occlusion of the LAA.
Sensitivity and predictivity of admission MCG for the presence of coronary artery disease (CAD) w... more Sensitivity and predictivity of admission MCG for the presence of coronary artery disease (CAD) were prospectively evaluated in 264 consecutive patients presenting with acute chest pain and without ST-segment elevation. Magnetocardiographic findings were compared with 12-lead electrocardiogram (ECG), echocardiography (ECHO), and troponin I in a headto-head design. Coronary angiography was used for the diagnosis of CAD. Specificity and positive predictive value of MCG were comparable with those of ECG and troponin I (N90%), whereas ECHO specificity and ECHO positive predictive value were lower (76.2% and 87.9%, respectively). Sensitivity and negative predictive value of MCG were twice as high as those in the ECG, troponin I, and ECHO tests. A subgroup of 62 patients presented with bundle-brunch block (BBB) (left BBB [LBBB], n = 32; right BBB [RBBB], n = 30; males, 41; females, 21). Specificity, sensitivity, as well as negative and positive predictive values of the 3 diagnostic tests at admission for the recognition of CAD in patients who have BBB presenting with acute chest pain are shown in the table.
Resumen Introduccion y objetivos A pesar de la eficacia de los anticoagulantes orales (ACO), algu... more Resumen Introduccion y objetivos A pesar de la eficacia de los anticoagulantes orales (ACO), algunos pacientes mantienen una alto riesgo residual y presentan ictus aun estando en tratamiento con ACO, y falta evidencia sobre el tratamiento de estos pacientes. El objetivo del estudio es analizar la seguridad y la eficacia del cierre percutaneo de la orejuela izquierda (OI) como prevencion secundaria para pacientes con fibrilacion auricular no valvular que han experimentado un ictus/accidente isquemico transitorio a pesar de los ACO (ictus resistente [IR]). Metodos Se estudio a 1.047 pacientes consecutivos con fibrilacion auricular no valvular sometidos a cierre percutaneo de la OI incluidos en el registro multicentrico Amplatzer Cardiac Plug. Se selecciono a los pacientes con IR como indicacion para el cierre de la OI, y se los comparo con pacientes con otras indicaciones. Resultados En un total de 115 pacientes (11%) se produjo un IR. Las escalas CHA2DS2-VASc y HAS-BLED eran significativamente mas altas en el grupo de IR (5,5 ± 1,5 frente a 4,3 ± 1,6; p Conclusiones Los pacientes con IR sometidos a cierre percutaneo de la OI presentaron resultados de seguridad similares que los pacientes sin IR, con una reduccion significativa de los eventos de ictus/accidente isquemico transitorio y hemorragia mayor durante el seguimiento.
Atrial fibrillation has been recognized as the most common arrhythmia in clinical practice, and i... more Atrial fibrillation has been recognized as the most common arrhythmia in clinical practice, and it is responsible for increasing morbidity and mortality associated with cardiogenic thromboembolism and stroke. Echocardiography and autopsy studies have shown that the vast majority of all thrombi in patients with atrial fibrillation form in the left atrial appendage (LAA) [1,2]. Cardiogenic emboli are responsible for at least a quarter of ischemic strokes, which are more frequently associated with persistent and severe disabilities compared with ischemic events attributable to vascular disease. Despite warfarin’s proven benefit, its effective delivery is challenged mostly by physicians’ fear of hemorrhage and the inconvenience of international normalized ratio (INR) monitoring for patients [2].
Clinical Hemorheology and Microcirculation, Jul 2, 2015
Eun-Seok Shina, Soe Hee Anna, Johannes Brachmannb, Yat-Yin Lamc, Friedrich Jungd and Jai-Wun Park... more Eun-Seok Shina, Soe Hee Anna, Johannes Brachmannb, Yat-Yin Lamc, Friedrich Jungd and Jai-Wun Parka,∗ aDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea bCoburg Hospital, 2nd Medical Department, Coburg, Germany cPrince of Wales Hospital, Chinese University of Hong Kong, Hong Kong dInstitute for Clinical Hemostasiology and Transfusion Medicine, Saarland University, Homburg/Saar, Germany
Our knowledge of the identity and functional significance of the pathogenic mechanisms responsibl... more Our knowledge of the identity and functional significance of the pathogenic mechanisms responsible for restenosis and arteriosclerosis in man is still limited. Among others, phenotypic conversion, migration, and proliferation of smooth muscle cells have been suggested to lead to hypercellular neointima. In the present study, we examined intimal cell numbers and cell types in tissue of 23 postangioplasty lesions biopsied by directional atherectomy. using histology and transmission electron microscopy. Comparative tissue analysis was performed for 53 primary lesions. Tissue specimens obtained from coronary (n = 32) and peripheral lesions (n = 44) of 69 symptomatic patients were analyzed. Histological assessment of cell density showed intra‐ and interlesional variability. A markedly (P < 0.001) higher cellularity was found in postangioplasty compared to primary lesions, irrespective of coronary or peripheral origin. Cell density in renarrowed tissue following angioplasty (2 to 30 mo...
The interventional left atrial appendage closure (LAAC) is an emerging alternative to oral antico... more The interventional left atrial appendage closure (LAAC) is an emerging alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) in concomitance with a contraindication for standard OAC. This subanalysis of the LAARGE registry aims to investigate on differences between different LAA morphologies in a real-world setting. This prospective, multicenter, observational registry included 562 patients from 37 centers with ineligibility for long-term OAC between April 2014 and January 2016. Baseline characteristics, indications, procedural data and complications were registered according to each LAA morphology (i.e., chicken wing, cauliflower, windsock, cactus and atypical morphologies). Implantation success was high across the 4 typical anatomies (≥ 98%, p=n.s.), only atypical anatomies exhibited a lower success rate (94%). The cactus shaped LAA was linked to a trend towards a shorter and the atypical LAAs to a prolonged fluoroscopy time (p=0.058 and p=0.009 versus the overall mean, respectively). Periprocedural and intra-hospital complications were generally rare, with no differences between the different morphologies (p=n.s.). Procedural success as well as complication rates of LAAC were not different amongst the 4 typical LAA morphologies. Only in patients with atypical LAA morphologies a lower implantation success was obvious.
Catheterization and Cardiovascular Interventions, Mar 8, 2011
In most patients with atrial fibrillation (AF) and stroke, there is thrombotic embolization from ... more In most patients with atrial fibrillation (AF) and stroke, there is thrombotic embolization from the left atrial appendage (LAA). Percutaneous closure of the LAA is a novel alternative for the treatment of patients with AF at a high risk of stroke, in whom long-term anticoagulation therapy is not possible or not desired. This study details the initial experience with the Amplatzer Cardiac Plug (ACP) in humans. Investigator-initiated retrospective preregistry data collection to evaluate procedural feasibility and safety up to 24 hr after implantation of the ACP, a nitinol device designed for percutaneous trans-septal implantation in LAA of patients with paroxysmal, permanent, or persistent AF. In 137 of 143 patients, LAA occlusion was attempted, and successfully performed in 132 (96%). There were serious complications in 10 (7.0%) patients (three patients with ischemic stroke; two patients experienced device embolization, both percutaneously recaptured; and five patients with clinically significant pericardial effusions). Minor complications were insignificant pericardial effusions in four, transient myocardial ischemia in two, and loss of the implant in the venous system in one patient. The implantation of the ACP device is a feasible method for percutaneous occlusion of the LAA.
Sensitivity and predictivity of admission MCG for the presence of coronary artery disease (CAD) w... more Sensitivity and predictivity of admission MCG for the presence of coronary artery disease (CAD) were prospectively evaluated in 264 consecutive patients presenting with acute chest pain and without ST-segment elevation. Magnetocardiographic findings were compared with 12-lead electrocardiogram (ECG), echocardiography (ECHO), and troponin I in a headto-head design. Coronary angiography was used for the diagnosis of CAD. Specificity and positive predictive value of MCG were comparable with those of ECG and troponin I (N90%), whereas ECHO specificity and ECHO positive predictive value were lower (76.2% and 87.9%, respectively). Sensitivity and negative predictive value of MCG were twice as high as those in the ECG, troponin I, and ECHO tests. A subgroup of 62 patients presented with bundle-brunch block (BBB) (left BBB [LBBB], n = 32; right BBB [RBBB], n = 30; males, 41; females, 21). Specificity, sensitivity, as well as negative and positive predictive values of the 3 diagnostic tests at admission for the recognition of CAD in patients who have BBB presenting with acute chest pain are shown in the table.
Resumen Introduccion y objetivos A pesar de la eficacia de los anticoagulantes orales (ACO), algu... more Resumen Introduccion y objetivos A pesar de la eficacia de los anticoagulantes orales (ACO), algunos pacientes mantienen una alto riesgo residual y presentan ictus aun estando en tratamiento con ACO, y falta evidencia sobre el tratamiento de estos pacientes. El objetivo del estudio es analizar la seguridad y la eficacia del cierre percutaneo de la orejuela izquierda (OI) como prevencion secundaria para pacientes con fibrilacion auricular no valvular que han experimentado un ictus/accidente isquemico transitorio a pesar de los ACO (ictus resistente [IR]). Metodos Se estudio a 1.047 pacientes consecutivos con fibrilacion auricular no valvular sometidos a cierre percutaneo de la OI incluidos en el registro multicentrico Amplatzer Cardiac Plug. Se selecciono a los pacientes con IR como indicacion para el cierre de la OI, y se los comparo con pacientes con otras indicaciones. Resultados En un total de 115 pacientes (11%) se produjo un IR. Las escalas CHA2DS2-VASc y HAS-BLED eran significativamente mas altas en el grupo de IR (5,5 ± 1,5 frente a 4,3 ± 1,6; p Conclusiones Los pacientes con IR sometidos a cierre percutaneo de la OI presentaron resultados de seguridad similares que los pacientes sin IR, con una reduccion significativa de los eventos de ictus/accidente isquemico transitorio y hemorragia mayor durante el seguimiento.
Atrial fibrillation has been recognized as the most common arrhythmia in clinical practice, and i... more Atrial fibrillation has been recognized as the most common arrhythmia in clinical practice, and it is responsible for increasing morbidity and mortality associated with cardiogenic thromboembolism and stroke. Echocardiography and autopsy studies have shown that the vast majority of all thrombi in patients with atrial fibrillation form in the left atrial appendage (LAA) [1,2]. Cardiogenic emboli are responsible for at least a quarter of ischemic strokes, which are more frequently associated with persistent and severe disabilities compared with ischemic events attributable to vascular disease. Despite warfarin’s proven benefit, its effective delivery is challenged mostly by physicians’ fear of hemorrhage and the inconvenience of international normalized ratio (INR) monitoring for patients [2].
Clinical Hemorheology and Microcirculation, Jul 2, 2015
Eun-Seok Shina, Soe Hee Anna, Johannes Brachmannb, Yat-Yin Lamc, Friedrich Jungd and Jai-Wun Park... more Eun-Seok Shina, Soe Hee Anna, Johannes Brachmannb, Yat-Yin Lamc, Friedrich Jungd and Jai-Wun Parka,∗ aDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea bCoburg Hospital, 2nd Medical Department, Coburg, Germany cPrince of Wales Hospital, Chinese University of Hong Kong, Hong Kong dInstitute for Clinical Hemostasiology and Transfusion Medicine, Saarland University, Homburg/Saar, Germany
Our knowledge of the identity and functional significance of the pathogenic mechanisms responsibl... more Our knowledge of the identity and functional significance of the pathogenic mechanisms responsible for restenosis and arteriosclerosis in man is still limited. Among others, phenotypic conversion, migration, and proliferation of smooth muscle cells have been suggested to lead to hypercellular neointima. In the present study, we examined intimal cell numbers and cell types in tissue of 23 postangioplasty lesions biopsied by directional atherectomy. using histology and transmission electron microscopy. Comparative tissue analysis was performed for 53 primary lesions. Tissue specimens obtained from coronary (n = 32) and peripheral lesions (n = 44) of 69 symptomatic patients were analyzed. Histological assessment of cell density showed intra‐ and interlesional variability. A markedly (P < 0.001) higher cellularity was found in postangioplasty compared to primary lesions, irrespective of coronary or peripheral origin. Cell density in renarrowed tissue following angioplasty (2 to 30 mo...
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