Mohammad-Ali Jazayeri

Five years of keeping a watch on the left atrial appendage—how has the WATCHMAN fared?

Left atrial appendage closure (LAAC) is a promising site-directed therapy for stroke prevention in patients with non-valvular atrial fibrillation (AF) who are ineligible or contraindicated for long-term oral anticoagulation. A variety of LAAC modalities are available, including percutaneous endocardial occluder devices such as WATCHMANTM (Boston Scientific Corp., Marlborough, MA, USA), and an ever-increasing body of evidence is helping to define the optimal use of each technique. Similarly increased experience with LAAC has revealed challenges such as device-related thrombi and peri-device leaks for which the long-term significance and appropriate management are areas of active investigation. We review the evolution and long-term outcomes with the WATCHMANTM device with particular emphasis on the nuances of its use and its role in the broader landscape of appendageology.

USE OF AN ESOPHAGEAL RETRACTOR TO PREVENT THERMAL INJURIES DURING ATRIAL FIBRILLATION ABLATION: A MULTI-CENTER EXPERIENCE

Background: Rapid and significant rise in esophageal temperature (ET) during radiofrequency ablation (RFA) for atrial fibrillation (AF) can be an indicator of an esophageal injury and limits our ability to achieve pulmonary vein isolation(PVI) by incomplete left atrial posterior wall (PW)ablation.

REAL WORLD BATTERY LONGEVITY OF ST. JUDE MEDICAL IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS INCLUDED IN THE ADVISORY FOR PREMATURE BATTERY DEPLETION

Background: Very recently St Jude Medical (SJM) released an advisory regarding premature battery depletion in a family of implantable cardioverter-defibrillators (ICDs) including biventricular cardiac defibrillators (CRTDs). There have been reported cases of loss of pacing and inability to

UNINTERRUPTED NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS VERSUS WARFARIN IN PATIENTS UNDERGOING CARDIAC IMPLANTABLE ELECTRONIC DEVICE IMPLANTATION: A META-ANALYSIS

Background: Uninterrupted use of anticoagulation is currently preferred over bridging therapy during cardiac implantable electronic device (CIED) implantation. However, there is limited experience with uninterrupted non-vitamin K antagonist oral anticoagulants (NOAC) in this setting. We performed a

IMPLANTABLE CARDIOVERTER DEFIBRILLATOR FOR THE PREVENTION OF MORTALITY IN NON-ISCHEMIC CARDIOMYOPATHY: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Background: The survival benefit of Implantable cardioverter defibrillator (ICD) in ischemic cardiomyopathy with an ejection fraction (EF) of ≤35% is well established. However, there remains controversy regarding its benefit in non-ischemic cardiomyopathy (NICM). We performed a meta-analysis

LEFT ATRIAL APPENDAGE LIGATION WITH LARIAT DEVICE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: The LARIAT device is a percutaneous endo-epicardial left atrial appendage (LAA) exclusion system that is currently performed in high risk atrial fibrillation (AF) patients intolerant to oral anticoagulation for stroke prevention and maybe reduction of AF burden. Methods: A comprehensive

SAFETY PROFILES OF PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE DEVICES: AN ANALYSIS OF THE FOOD AND DRUG ADMINISTRATION MANUFACTURER AND USER FACILITY DEVICE EXPERIENCE DATABASE FROM 2009 – 2016

Background: Percutaneous left atrial appendage closure (LAAC) is effective for stroke prevention in atrial fibrillation (AF) patients unable to tolerate long-term oral anticoagulation. We analyzed the safety of two commonly used LAAC methods using surveillance data from the FDA MAUDE database.

META-ANALYSIS ON THE EFFICACY AND SAFETY OF NEW ORAL ANTICOAGULANTS COMPARED WITH VITAMIN K ANTAGONISTS IN PATIENTS UNDERGOING CARDIOVERSION FOR ATRIAL FIBRILLATION

Background: Novel oral anticoagulants (NOACs) have been found to be safe and effective for the prevention of systemic thromboembolim (STE) in non-valvular atrial fibrillation (AF) but their experience in patients undergoing cardioversion (CV) is limited. Methods: A comprehensive literature search

Impact of Radiofrequency Ablation of Atrial Fibrillation on Pulmonary Vein Cross Sectional Area: Implications for the Diagnosis of Pulmonary Vein Stenosis

Introduction Restoration of normal sinus rhythm by radiofrequency ablation (RFA) in atrial fibrillation (AF) patients can result in a reduction of left atrial (LA) volume and pulmonary vein (PV) dimensions. It is not clear if this PV size reduction represents a secondary effect of overall LA volume reduction or true PV stenosis. We assessed the relationship between LA volume reduction and PV orifice area pre- and post-RFA. Methods A retrospective cohort study was conducted at a tertiary care academic hospital. Pre- and post-RFA cardiac computed tomography (CT) studies of 100 consecutive AF patients were reviewed. Studies identifying obvious segmental PV narrowing were excluded. Left atrial volumes and PV orifice cross-sectional areas (PVOCA) were measured using proprietary software from the CT scanner vendor (GE Healthcare, Waukesha, WI). Results The cohort had a mean age of 60 ± 8 years, 73% were male, and 90% were Caucasian. Non-paroxysmal AF was present in 76% of patients with a mean duration from diagnosis to RFA of 55 ± 54 months. Mean procedural time was 244 ± 70 min. AF recurred in 27% at 3 month follow-up. Pre-RFA LA volumes were 132 ± 60 ml and mean PVOCA was 2.89 ± 2.32 cm2. In patients with successful ablation, mean LA volume decreased by 10% and PVOCA decreased by 21%. PVOCA was significantly reduced in patients with successful RFA compared to those who had recurrence (2.18 ± 1.12 vs. 2.8 ± 1.9 cm2, p = 0.04) but reduction in LA volume between groups was not significant (118 ± 42 vs. 133 ± 54 ml, p=0.15). Conclusions The study demonstrates that both PV orifice dimensions and LA volume are reduced after successful AF ablation. These data warrant a reassessment of criteria for diagnosing PV stenosis based on changes in PV caliber alone, ideally incorporating LA volume changes.

Subcutaneous implantable cardioverter-defibrillator placement in a patient with a preexisting transvenous implantable cardioverter-defibrillator

Introduction The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a safe and effective treatment for prevention of sudden cardiac death. It is typically not used in patients who require additional therapies conferred by transvenous implantable cardioverter-defibrillator (TV-ICD) systems, such as bradycardia pacing or antitachycardia pacing (ATP) for ventricular tachycardia (VT). Despite reports of successful S-ICD implantation in patients with other cardiac implantable electronic devices (CIEDs), we are not aware of any reports to date in which S-ICD implantation complemented a pre-existing TV-ICD as a backup device for successful defibrillation. We report the case of a patient who presented with this clinical dilemma.