ELETTROFISIOLOGIA OSPEDALE MAURIZIANO -TORINO-


Madden JL. Resection of the left auricular appendix lAMA 1948;140:769 -72.

Inability to achieve high rates of LAA successful occlusion The highest success rate was 93% Means success rate 55–66% successful occlusion in a variety of methods including stapling, ligation and amputation.


B. UNSWORTH JACC 2011

IMPROPER POSITIONINGPERI DEVICE LEAKS


jce


jce

IMPROPER POSITIONING


DEVICE RELATED THROMBUSThe majority of thrombi at 6 month follow up

• All patients should be assessed for thrombus at 45 day, 6 month and 12 month follow up TEE visits.

• The following medication regimen is recommended.

• Discontinue ASA/Plavix and restart coumadin for at least 12weeks. Repeat TEE after 12 weeks

• If thrombus is resolved on the follow-up TEE,patient may resume ASA 325mg until the next scheduled follow-up visit.


•Non-Rheumatic AF found thrombus present in 12.6% of patients.

•90% of the thrombus was found in the LAA

Orhan Onalan and Eugene Crystal, Stroke 2007;38;624-630ELETTROFISIOLOGIA OSPEDALE MAURIZIANO -TORINO-

COMBINED END POINT

Stroke, cardiovascular/unexplained death, systemic cardioembolization

Watchman group (RR:0,68)

32%

800 pts non valvular AF CHADS2 > 1

Randomization 2:1 warfarin/ watchman

Procedure warfarin 45 days clopidogrel +ASA 6 months ASA

PROTECT AF

COMPLICATIONS

Overall: 12,3%

Pericardial tamponade : 5%

Stroke : 1 %

Removal : 4 pts ( sepsis/embolisation)

Surgical intervention: 2,2%

Holmes DR Lancet 2009;374:534-42ELETTROFISIOLOGIA OSPEDALE MAURIZIANO -TORINO-

RELY STUDYTIME TO FIRST STROKE OR SSE

Warfarin

Years

RRR35%

Cum

ulat

ive

haza

rd r

ates

0

0.01

0.02

0.03

0.05

0.04

0.0

0.5 1.0 1.5 2.0 2.5

RR 0.90(95% CI: 0.74–1.10)P<0.001 (NI)P=0.30 (Sup)

RR 0.65(95% CI: 0.52–0.81)P<0.001 (NI)P<0.001 (Sup)

RR = relative risk; RRR = relative risk reduction; SSE = systemic embolism.Dabigatran etexilate is not approved for clinical use in stroke prevention in atrial fibrillation outside the US and Canada.Connolly SJ, et al. N Engl J Med 2010;363:1875-1876.

Dabigatran 150 mg BID Dabigatran 110 mg BID

3.0


Apixaban WarfarinEvent Rate 1.27 1.60

HR (95% CI): 0.79 (0.66, 0.95)

P-value Non-Inferiority <0.001

P-value Superioriy = 0.01

Apixaban Warfarin

Event Rate 2.13 3.09

HR (95% CI): 0.69 (0.60, 0.80)

P-value <0.001


3% SR no OAT

23% AF , OAT



CONCLUSION

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