Left Atrial Appendage Occlusion for The Unmet Clinical Needs of Stroke Prevention in Nonvalvular Atrial Fibrillation David R. Holmes, MD, Mohamad Alkhouli,

Slides:

Advertisements

Similar presentations

WATCHMAN™ Left Atrial Appendage Closure Device

Advertisements

Protecting Against Stroke

PROTECT-AF (LAA Closure with Watchman vs Warfarin in AF and Stroke) A long-term (45-month) follow-up analysis of device therapy with Watchman vs warfarin.

Atrial Fibrillation Warfarin and its newer alternatives

Left atrial appendage occlusion: Ready for prime time? David Hildick-Smith Sussex Cardiac Centre Brighton, UK.

Celebrating the Sesquicentennial of Mayo Clinic: 150 Years of Advances in Medical Practice, Education, Research, and Professionalism William L. Lanier,

Post-FDA Approval, Initial US Clinical Experience with Watchman Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation Vivek Y. Reddy.

Post-FDA Approval, Initial US Clinical Experience with Watchman Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation Vivek Y. Reddy.

LAA Closure: Lessons from the Pivotal Studies & Three Advisory Panels

Update on the Watchman Device CRT 2010 Washington, DC

Occlusion: Patient Selection Are the Data Supportive?

CRT 2017: Putting LAA closure in the age of DOACs into perspective

David R. Holmes, Jr., M.D. Mayo Clinic, Rochester

L-Carnitine in the Secondary Prevention of Cardiovascular Disease: Systematic Review and Meta-analysis James J. DiNicolantonio, PharmD, Carl J. Lavie,

Pleomorphic Adenoma in the Parotid Gland

Ductal Carcinoma in Situ of the Breast

Use of the Coronary Artery Calcium Score in Discussion of Initiation of Statin Therapy in Primary Prevention Erin D. Michos, MD, MHS, Michael J. Blaha,

Atrial Fibrillation in the 21st Century: A Current Understanding of Risk Factors and Primary Prevention Strategies Arthur R. Menezes, MD, Carl J. Lavie,

Embolic Origin of Osler Nodes

Evaluation of Proteinuria

Treatment of Nightmares With Prazosin: A Systematic Review

William L. Lanier, MD Mayo Clinic Proceedings

Effect of Race on the Incidence of Aortic Stenosis and Outcomes of Aortic Valve Replacement in the United States Fahad Alqahtani, MD, Sami Aljohani,

Management of Adult Onset Seizures

Left atrial appendage closure: A new technique for clinical practice

Watching for the Patient With AF: Latest Advances and Technologies

Net Clinical Benefit of Non-vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Phase III Atrial Fibrillation Trials Giulia Renda, MD, PhD, Marta.

Direct-to-Consumer Testing 2

Gestational Trophoblastic Disease

Succinct Review of the New VTE Prevention and Management Guidelines

Utility of Left Ventricular Ejection Fraction Measurements Before the Administration of Doxorubicin-Based Chemotherapy in Patients With Diffuse Large.

Topical Analgesics in the Management of Acute and Chronic Pain

Influence of Renal Function on the Pharmacokinetics, Pharmacodynamics, Efficacy, and Safety of Non–Vitamin K Antagonist Oral Anticoagulants Matthew R.

Acupuncture Mayo Clinic Proceedings

Madonna della Pietá by Michelangelo

Left atrial appendage exclusion: An alternative to anticoagulation in nonvalvular atrial fibrillation Kareem Bedeir, MBChB, MS, David R. Holmes, MD,

Pancreatic Ductal Adenocarcinoma

Medical management of osteoarthritis

Should Procedures or Patients Be Safe

Patient-Initiated Second Opinions: Systematic Review of Characteristics and Impact on Diagnosis, Treatment, and Satisfaction Velma L. Payne, PhD, Hardeep.

Case-Based Discussion Regarding Challenges in Patient Selection and Procedural Planning in Left Atrial Appendage Occlusion Sidakpal S. Panaich, MD, Thomas.

Pharmacogenomics: Precision Medicine and Drug Response

Best Practices for Patients With Chronic Migraine

Postmarketing Safety-Related Modifications of Drugs Approved by the US Food and Drug Administration Between 1999 and 2014 Without Randomized Controlled.

Classic Hodgkin Lymphoma

Termination of anticoagulation therapy at 45 days after concomitant atrial fibrillation catheter ablation and left atrial appendage occlusion resulting.

Management of Adult Onset Seizures

L-Carnitine in the Secondary Prevention of Cardiovascular Disease: Systematic Review and Meta-analysis James J. DiNicolantonio, PharmD, Carl J. Lavie,

Pleomorphic Adenoma in the Parotid Gland

Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: Prevention of Stroke and Systemic Thromboembolism in Atrial Fibrillation and Flutter

Renal Pyelocalyceal Squamous Cell Carcinoma

Evaluation and Management of Penicillin Allergy

Jöns Jacob Berzelius – A Father of Chemistry

Evaluating the Patient With Diarrhea: A Case-Based Approach

Van Gogh’s Portrait of Dr Gachet

Institutional Review Boards: What Clinician Researchers Need to Know

Diabetic Mastopathy Mayo Clinic Proceedings

Hepatocellular Carcinoma

Down River by Charles Munch

Pulmonary Tumor Embolism of Unknown Origin

Celebrating the Sesquicentennial of Mayo Clinic: 150 Years of Advances in Medical Practice, Education, Research, and Professionalism William L. Lanier,

Mantle Cell Involvement of the Spleen

Squamous Cell Carcinoma of the Tongue

Preoperative Smoking Cessation: The Role of the Primary Care Provider

Is There an “Asymptote of Gain” Beyond Which Further Increases in Cardiorespiratory Fitness Convey No Additional Benefits on Mortality and Atrial Fibrillation?

Autonomic Tone and Benefits of Cardiac Rehabilitation Programs

Diagnosis and Management of Headache in Older Adults

Gianluigi Savarese et al. JCHF 2016;4:

Acute and Chronic Seizures in Patients Older Than 60 Years

Mayo Clinic Proceedings 2012: “A New Era in Journal Stewardship”

Presentation transcript:

Left Atrial Appendage Occlusion for The Unmet Clinical Needs of Stroke Prevention in Nonvalvular Atrial Fibrillation David R. Holmes, MD, Mohamad Alkhouli, MD, Vivek Reddy, MD Mayo Clinic Proceedings Volume 94, Issue 5, Pages 864-874 (May 2019) DOI: 10.1016/j.mayocp.2018.09.025 Copyright © 2019 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Adherence to antithrombotic therapy for stroke prevention in patients with atrial fibrillation in clinical practice. NOAC = novel oral anticoagulation. Mayo Clinic Proceedings 2019 94, 864-874DOI: (10.1016/j.mayocp.2018.09.025) Copyright © 2019 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Source of cardiac emboli and confirmation of the role of left atrial appendage exclusion for stroke prevention in patients with atrial fibrillation. A, Origin of cardiac emboli in patients with atrial fibrillation (Blackshear et al3). B, Confirmation of the role of left atrial appendage exclusion for stroke prevention in patients with atrial fibrillation (Reddy et al12). CVA = cerebrovascular accident; LAA = left atrial appendage. Mayo Clinic Proceedings 2019 94, 864-874DOI: (10.1016/j.mayocp.2018.09.025) Copyright © 2019 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Patient-level meta-analysis of the randomized clinical trials comparing the Watchman device with warfarin for stroke prevention in patients with atrial fibrillation. CV = cardiovascular; HR = hazard ratio; MRS = Modified Rankin Score; SE = systemic embolization. Mayo Clinic Proceedings 2019 94, 864-874DOI: (10.1016/j.mayocp.2018.09.025) Copyright © 2019 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 4 Procedural success rates in patients undergoing percutaneous left atrial appendage occlusion with the Watchman device in randomized clinical trials and prospective registries. ASAP = ASA Plavix Feasibility Study With WATCHMAN Left Atrial Appendage Closure Technology; CAP = Continuous Access Registry; EWOLUTION = Registry on WATCHMAN Outcomes in Real-Life Utilization; FDA = Food and Drug Administration; PAF = PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic PROTECTion in Patients With Atrial Fibrillation) trial; PREVAIL = Evaluation of the WATCHMAN Left Atrial Appendage (LAA) Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy; WASP = Registry on Watchman Outcomes in Real-Life Utilization. Mayo Clinic Proceedings 2019 94, 864-874DOI: (10.1016/j.mayocp.2018.09.025) Copyright © 2019 Mayo Foundation for Medical Education and Research Terms and Conditions