2024
Anticoagulation Alone vs Anticoagulation Plus Aspirin or DAPT Following Left Atrial Appendage Occlusion
Reinhardt S, Gibson D, Hsu J, Kapadia S, Yeh R, Price M, Piccini J, Nair D, Christen T, Allocco D, Freeman J. Anticoagulation Alone vs Anticoagulation Plus Aspirin or DAPT Following Left Atrial Appendage Occlusion. Journal Of The American College Of Cardiology 2024, 84: 889-900. PMID: 39197978, DOI: 10.1016/j.jacc.2024.05.067.Peer-Reviewed Original ResearchConceptsLeft atrial appendage occlusionRate of adverse eventsAdverse eventsLAA closure deviceAppendage occlusionAntithrombotic strategiesP2Y<sub>12</sub> inhibitorsDays of follow-upMultivariable Cox proportional hazards regressionClosure deviceRisk of adverse eventsCox proportional hazards regressionWatchman FLX deviceDual antiplatelet therapyDevice-related thrombusProportional hazards regressionStroke/transient ischemic attackAntithrombotic regimensFLX deviceAntiplatelet therapyDOACsGroup patientsFollow-upMultivariate analysisHazards regressionProcedure Volume and Outcomes With WATCHMAN Left Atrial Appendage Occlusion
Friedman D, Du C, Zimmerman S, Tan Z, Lin Z, Vemulapalli S, Kosinski A, Piccini J, Pereira L, Minges K, Faridi K, Masoudi F, Curtis J, Freeman J. Procedure Volume and Outcomes With WATCHMAN Left Atrial Appendage Occlusion. Circulation Cardiovascular Interventions 2024, 17: e013466. PMID: 38889251, PMCID: PMC11189610, DOI: 10.1161/circinterventions.123.013466.Peer-Reviewed Original ResearchConceptsVolume-outcome relationshipLikelihood of procedural successLeft atrial appendage occlusionProcedural successProcedure volumeAppendage occlusionNational Cardiovascular Data Registry LAAO RegistryVolume quartilesLeft atrial appendage occlusion devicesThree-level hierarchical generalized linear modelsMinimum volume thresholdsWatchman FLX deviceProcedural success rateHierarchical generalized linear modelsAssociated with outcomePhysician volumeWATCHMAN procedureFLX deviceOcclusion deviceVolume thresholdCardiovascular proceduresPhysiciansHospitalNational analysisSuccess rateIn-hospital safety outcomes of left atrial appendage occlusion in octogenarians and nonagenarians
Ismayl M, Ahmed H, Goldsweig A, Freeman J, Alkhouli M. In-hospital safety outcomes of left atrial appendage occlusion in octogenarians and nonagenarians. EP Europace 2024, 26: euae055. PMID: 38391186, PMCID: PMC10927254, DOI: 10.1093/europace/euae055.Peer-Reviewed Original ResearchConceptsOutcomes of left atrial appendage occlusionLeft atrial appendage occlusionIn-hospital all-cause mortalityOdds of vascular complicationsLength of stayAll-cause mortalityYounger patientsAppendage occlusionComposite of in-hospital all-cause mortalityOdds of in-hospital all-cause mortalityVascular complicationsSafety outcomesAcute kidney injuryNational Inpatient Sample databaseRetrospective cohort studyInpatient Sample databaseYears of ageCardiac tamponadeBlood transfusionProcedural complicationsSafety profileKidney injuryLogistic regression modelsElderly patientsCohort studyAmulet Occluder Implantation in Patients With Failed Prior Left Atrial Appendage Occlusion EMERGE LAA Insights
Alkhouli M, Makkar A, Freeman J, Ellis C, Shah A, Gada H, Coylewright M, Lo M, Agarwal H, Lakkireddy D. Amulet Occluder Implantation in Patients With Failed Prior Left Atrial Appendage Occlusion EMERGE LAA Insights. JACC Cardiovascular Interventions 2024, 17: 457-459. PMID: 38355277, DOI: 10.1016/j.jcin.2023.12.012.Peer-Reviewed Original ResearchSafety and Efficacy of Combining Left Atrial Appendage Occlusion With Another Cardiac Procedure
Ismayl M, Ahmed H, Freeman J, Alkhouli M, Lakkireddy D, Goldsweig A. Safety and Efficacy of Combining Left Atrial Appendage Occlusion With Another Cardiac Procedure. JACC Cardiovascular Interventions 2024, 17: 262-273. PMID: 38267141, DOI: 10.1016/j.jcin.2023.10.017.Peer-Reviewed Original ResearchMeSH KeywordsAtrial AppendageAtrial FlutterHumansRetrospective StudiesStrokeTreatment OutcomeVascular System InjuriesConceptsLeft atrial appendage occlusionLength of stayCardiac proceduresIn-hospital mortalityAppendage occlusionOutcomes of left atrial appendage occlusionConcomitant transcatheter aortic valve replacementVascular injuryTranscatheter aortic valve replacementConcomitant procedure groupConcomitant cardiac proceduresAortic valve replacementOdds of MACEAcute kidney injuryNational Inpatient Sample databaseRetrospective cohort studyRetrospective observational studyAdverse cardiovascular eventsInpatient Sample databaseOdds of strokeFlutter ablationValve replacementBlood transfusionClinical outcomesHeart block
2023
DAPT Is Comparable to OAC Following LAAC With WATCHMAN FLX A National Registry Analysis
Coylewright M, Holmes D, Kapadia S, Hsu J, Gibson D, Freeman J, Yeh R, Piccini J, Price M, Allocco D, Nair D. DAPT Is Comparable to OAC Following LAAC With WATCHMAN FLX A National Registry Analysis. JACC Cardiovascular Interventions 2023, 16: 2708-2718. PMID: 37943200, DOI: 10.1016/j.jcin.2023.08.013.Peer-Reviewed Original ResearchConceptsDual antiplatelet therapyDevice-related thrombusOral anticoagulationWatchman FLXStroke preventionLong-term oral anticoagulationComposite endpoint rateMedical therapy optionsNational registry analysisSimilar safety profilePropensity-matched analysisAtrial appendage occlusionAspirin patientsDAPT patientsMajor bleedingAntiplatelet therapyComposite endpointDrug regimensMedication regimensAppendage occlusionComorbid conditionsAtrial fibrillationRegistry analysisSafety profileMean ageIntracardiac vs Transesophageal Echocardiography for Left Atrial Appendage Occlusion With Watchman FLX in the U.S.
Ferro E, Alkhouli M, Nair D, Kapadia S, Hsu J, Gibson D, Freeman J, Price M, Roy K, Allocco D, Yeh R, Piccini J. Intracardiac vs Transesophageal Echocardiography for Left Atrial Appendage Occlusion With Watchman FLX in the U.S. JACC Clinical Electrophysiology 2023, 9: 2587-2599. PMID: 37831030, DOI: 10.1016/j.jacep.2023.08.004.Peer-Reviewed Original ResearchMeSH KeywordsAtrial AppendageAtrial FibrillationCardiac CatheterizationEchocardiography, TransesophagealHumansPericardial EffusionConceptsAtrial appendage occlusionTransesophageal echocardiographyIntracardiac echocardiographyBaseline characteristicsAppendage occlusionLeft atrial appendage occlusionPericardial effusion rateSuccessful device implantationAdverse event ratesSimilar baseline characteristicsUnadjusted mortality ratesHigh rateICE patientsTEE patientsPericardial effusionPivotal trialsDevice implantationGeneral anesthesiaAdjusted comparisonsProcedural timeLAAO devicesDevice deliveryMortality rateEvent ratesEchocardiographyImpact of Preprocedure Imaging for Left Atrial Appendage Occlusion Insights From the NCDR LAAO Registry
Clarke J, Higgins A, Wang Y, Faridi K, Curtis J, Freeman J, Friedman D. Impact of Preprocedure Imaging for Left Atrial Appendage Occlusion Insights From the NCDR LAAO Registry. JACC Cardiovascular Interventions 2023, 16: 1317-1328. PMID: 37316143, DOI: 10.1016/j.jcin.2023.05.008.Peer-Reviewed Original ResearchMeSH KeywordsAtrial AppendageHumansHypertensionRegistriesTomography, X-Ray ComputedTreatment OutcomeConceptsDevice successImplantation successPreprocedure imagingProcedure successLAAO proceduresAbnormal renal functionAtrial appendage occlusionMultivariable logistic regressionOutcomes of interestMagnitude of benefitLAAO implantationPrior thromboembolismUncontrolled hypertensionRate of useRenal functionAppendage occlusionProcedural successUniversity HospitalLogistic regressionCMR useOverall rateCMRPatientsPreprocedureRegistryWatchman device migration and embolization: A report from the NCDR LAAO Registry
Friedman D, Freeman J, Zimmerman S, Tan Z, Pereira L, Faridi K, Curtis J. Watchman device migration and embolization: A report from the NCDR LAAO Registry. Journal Of Cardiovascular Electrophysiology 2023, 34: 1192-1195. PMID: 37078339, PMCID: PMC10290479, DOI: 10.1111/jce.15909.Peer-Reviewed Original ResearchConceptsWATCHMAN procedureSurgical retrievalDevice migrationMortality rateAtrial appendage closure deviceHospital mortality rateAnnual procedure volumeCardiac surgeryHospital eventsPostdischarge eventsOstial sizeDevice embolizationTaller patientsRetrospective analysisClosure deviceLAA ostiumPatientsProcedure volumeHigh mortalitySurgerySubstantial proportionEmbolizationRegistryGreater body massBody massSCAI/HRS expert consensus statement on transcatheter left atrial appendage closure
Saw J, Holmes D, Cavalcante J, Freeman J, Goldsweig A, Kavinsky C, Moussa I, Munger T, Price M, Reisman M, Sherwood M, Turi Z, Wang D, Whisenant B. SCAI/HRS expert consensus statement on transcatheter left atrial appendage closure. Heart Rhythm 2023, 20: e1-e16. PMID: 36990925, DOI: 10.1016/j.hrthm.2023.01.007.Peer-Reviewed Original ResearchSCAI/HRS Expert Consensus Statement on Transcatheter Left Atrial Appendage Closure
Saw J, Holmes D, Cavalcante J, Freeman J, Goldsweig A, Kavinsky C, Moussa I, Munger T, Price M, Reisman M, Sherwood M, Turi Z, Wang D, Whisenant B. SCAI/HRS Expert Consensus Statement on Transcatheter Left Atrial Appendage Closure. JACC Cardiovascular Interventions 2023, 16: 1384-1400. PMID: 36990858, DOI: 10.1016/j.jcin.2023.01.011.Peer-Reviewed Original Research
2022
Device-Sizing and Associated Complications With Left Atrial Appendage Occlusion: Findings From the NCDR LAAO Registry
Sandhu A, Varosy P, Du C, Aleong R, Tumolo A, West J, Tzou W, Curtis J, Freeman J, Friedman D, Hess P. Device-Sizing and Associated Complications With Left Atrial Appendage Occlusion: Findings From the NCDR LAAO Registry. Circulation Cardiovascular Interventions 2022, 15: e012183. PMID: 36472194, DOI: 10.1161/circinterventions.122.012183.Peer-Reviewed Original ResearchMeSH KeywordsAtrial AppendageAtrial FibrillationCardiac CatheterizationHumansPericardial EffusionRegistriesStrokeTreatment OutcomeConceptsAtrial appendage occlusionAppendage occlusionPericardial effusionLower oddsOversized deviceComposite adverse outcomeNonvalvular atrial fibrillationShort-term complicationsShort-term outcomesSignificant leakDevice embolismSelect patientsAdverse eventsWatchman deviceAssociated complicationsPeridevice leakAtrial fibrillationAdverse outcomesDevice embolizationHigh prevalenceDevice migrationManufacturer's recommendationsPatientsStudy periodUndersized devicesComparative Safety of Transcatheter LAAO With the First-Generation Watchman and Next-Generation Watchman FLX Devices
Price M, Friedman D, Du C, Wang Y, Lin Z, Curtis J, Freeman J. Comparative Safety of Transcatheter LAAO With the First-Generation Watchman and Next-Generation Watchman FLX Devices. JACC Cardiovascular Interventions 2022, 15: 2115-2123. PMID: 36357014, DOI: 10.1016/j.jcin.2022.09.002.Peer-Reviewed Original ResearchConceptsHospital major adverse eventsMajor adverse eventsWatchman FLXMajor vascular complicationsMajor bleedingPericardial effusionCardiac arrestDevice embolizationVascular complicationsMyocardial infarctionLower ratesSystemic arterial embolismComposite of deathTransient ischemic attackAtrial appendage occlusionSignificant lower rateBalance of risksHospital mortalityIschemic attackArterial embolismHospital outcomesPrimary endpointStroke preventionAdverse eventsProcedural complicationsDevelopment and validation of an automated algorithm for end point adjudication for a large U.S. national registry
Friedman DJ, Pierre D, Wang Y, Gambone L, Koutras C, Segawa C, Farb A, Vemulapalli S, Varosy PD, Masoudi FA, Lansky A, Curtis JP, Freeman JV. Development and validation of an automated algorithm for end point adjudication for a large U.S. national registry. American Heart Journal 2022, 254: 102-111. PMID: 36007567, DOI: 10.1016/j.ahj.2022.08.006.Peer-Reviewed Original ResearchMeSH KeywordsAftercareAtrial AppendageAtrial FibrillationHumansIschemic Attack, TransientPatient DischargeRegistriesStrokeTreatment OutcomeConceptsEnd point adjudicationCEC adjudicationEnd pointLarge registriesClinical trialsNational Cardiovascular Data RegistryMajor vascular complicationsU.S. National RegistryPost-discharge eventsAgreement rateMajor bleedingNeurologic eventsVascular complicationsNational registryEvent adjudicationData registryRegistryCommittee's evaluationsPercent agreementGold standardAgreement thresholdHospitalTrialsFurther confirmationBleedingLeft Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation : A Decision Analysis.
Chew DS, Zhou K, Pokorney SD, Matchar DB, Vemulapalli S, Allen LA, Jackson KP, Samad Z, Patel MR, Freeman JV, Piccini JP. Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation : A Decision Analysis. Annals Of Internal Medicine 2022, 175: 1230-1239. PMID: 35969865, DOI: 10.7326/m21-4653.Peer-Reviewed Original ResearchConceptsDirect oral anticoagulantsHigh bleeding riskLower stroke riskClinical effectiveness dataAtrial fibrillationBleeding riskStroke riskOral anticoagulantsIschemic strokeEffectiveness dataHAS-BLED scoreIndividual riskHigh stroke riskMajor bleeding riskNonvalvular atrial fibrillationPatient's individual riskPrimary end pointAtrial appendage occlusionBase-case analysisOral anticoagulationPrior strokeVASc scoreStroke preventionWatchman deviceAppendage occlusionIndications for Left Atrial Appendage Occlusion in the United States and Associated In-Hospital Outcomes: Results From the NCDR LAAO Registry
Daimee UA, Wang Y, Masoudi FA, Varosy PD, Friedman DJ, Du C, Koutras C, Reddy VY, Saw J, Price MJ, Kusumoto FM, Curtis JP, Freeman JV. Indications for Left Atrial Appendage Occlusion in the United States and Associated In-Hospital Outcomes: Results From the NCDR LAAO Registry. Circulation Cardiovascular Quality And Outcomes 2022, 15: e008418. PMID: 35959677, PMCID: PMC9388561, DOI: 10.1161/circoutcomes.121.008418.Peer-Reviewed Original ResearchConceptsHospital adverse eventsHigh fall riskNational Cardiovascular Data RegistryProcedural indicationsAtrial appendage occlusionAdverse eventsWatchman implantationFall riskMajor bleedsThromboembolic riskAppendage occlusionData registryAbnormal renal/liver functionLeft atrial appendage occlusionIn-Hospital OutcomesMean patient ageTransient ischemic attackMajority of patientsInternational normalized ratioIschemic attackMean CHAOral anticoagulationPrior strokeVASc scoreWATCHMAN procedureAbnormal left atrial body stiffness is predicted by appendage size: impact of appendage occlusion on left atrial mechanics assessed by pressure-volume analysis
Bregasi A, Freeman JV, Curtis JP, Akar JG, Ortiz-Leon XA, Maia JH, Higgins AY, Matthews RV, Sinusas AJ, McNamara RL, Sugeng L, Lin BA. Abnormal left atrial body stiffness is predicted by appendage size: impact of appendage occlusion on left atrial mechanics assessed by pressure-volume analysis. AJP Heart And Circulatory Physiology 2022, 323: h559-h568. PMID: 35960632, PMCID: PMC9576173, DOI: 10.1152/ajpheart.00083.2022.Peer-Reviewed Original ResearchConceptsLeft atrial appendage occlusionLA stiffnessAppendage occlusionLA appendageLA mechanicsTransesophageal echocardiographyPressure-volume analysisPercutaneous left atrial appendage occlusionAdverse atrial remodelingAtrial appendage occlusionLeft atrial appendageLA volume measurementsAtrial cardiomyopathyBaseline characteristicsLA complianceAtrial remodelingClinical outcomesAtrial appendageAtrial mechanicsCardiac performancePathophysiological roleBaseline parametersMagnitude of increaseAppendage sizeOcclusionPatient-Level Analysis of Watchman Left Atrial Appendage Occlusion in Practice Versus Clinical Trials
Friedman DJ, Du C, Wang Y, Agarwal V, Varosy PD, Masoudi FA, Holmes DR, Reddy VY, Price MJ, Curtis JP, Freeman JV. Patient-Level Analysis of Watchman Left Atrial Appendage Occlusion in Practice Versus Clinical Trials. JACC Cardiovascular Interventions 2022, 15: 950-961. PMID: 35512918, PMCID: PMC9370831, DOI: 10.1016/j.jcin.2022.02.029.Peer-Reviewed Original ResearchConceptsRegistry patientsHemorrhagic stroke riskIschemic strokeWarfarin patientsTrial patientsStroke riskLAAO patientsClinical practiceMore pericardial effusionsPeriprocedural ischemic strokePropensity-matched analysisAtrial appendage occlusionCox proportional hazardsPatient-level dataFine-Gray modelMore comorbiditiesPROTECT AFNoncardiovascular deathPericardial effusionHemorrhagic strokeAppendage occlusionDevice implantationTrial criteriaClinical trialsSimilar riskAntithrombotic Therapy After Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation
Freeman JV, Higgins AY, Wang Y, Du C, Friedman DJ, Daimee UA, Minges KE, Pereira L, Goldsweig AM, Price MJ, Reddy VY, Gibson D, Doshi SK, Varosy PD, Masoudi FA, Curtis JP. Antithrombotic Therapy After Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation. Journal Of The American College Of Cardiology 2022, 79: 1785-1798. PMID: 35512858, PMCID: PMC9097170, DOI: 10.1016/j.jacc.2022.02.047.Peer-Reviewed Original ResearchMeSH KeywordsAnticoagulantsAspirinAtrial AppendageAtrial FibrillationFibrinolytic AgentsFrailtyHumansStrokeTreatment OutcomeWarfarinConceptsLeft atrial appendage occlusionAdverse eventsPivotal trialsWatchman deviceTreatment protocolAntithrombotic strategiesAppendage occlusionLower riskFrailty regressionPercutaneous left atrial appendage occlusionNational Cardiovascular Data RegistryContemporary U.S. practiceDual antiplatelet therapyAtrial appendage occlusionConcomitant aspirinPostprocedure careAdjusted riskAntiplatelet therapyAntithrombotic medicationAntithrombotic therapyAtrial fibrillationAdverse outcomesTrial protocolAntithrombotic agentsMedication strategiesClinical Impact of Residual Leaks Following Left Atrial Appendage Occlusion Insights From the NCDR LAAO Registry
Alkhouli M, Du C, Killu A, Simard T, Noseworthy PA, Friedman PA, Curtis JP, Freeman JV, Holmes DR. Clinical Impact of Residual Leaks Following Left Atrial Appendage Occlusion Insights From the NCDR LAAO Registry. JACC Clinical Electrophysiology 2022, 8: 766-778. PMID: 35387751, PMCID: PMC9233062, DOI: 10.1016/j.jacep.2022.03.001.Peer-Reviewed Original ResearchMeSH KeywordsAtrial AppendageAtrial FibrillationHumansRegistriesThromboembolismTime FactorsTreatment OutcomeConceptsPeri-device leakAdverse eventsResidual leakMajor adverse eventsProportion of patientsAdverse clinical eventsAtrial appendage occlusionAnticoagulant utilizationMajor bleedingSystemic embolizationAppendage occlusionClinical eventsClinical impactHigher oddsHigh incidencePatientsThromboembolicSignificant differencesRegistryLarge leaksLAAOLeakHigher proportionDaysAnticoagulation