An under-recognized high-risk atrial fibrillation population

Analyzing transcatheter mitral valve repair patients for left atrial appendage closure device application

Colleen E. Lane, Mackram Eleid, David Holmes

Research output: Contribution to journalArticle

Abstract

Objective: Identify patients undergoing transcatheter mitral valve repair (TMVR) who could potentially benefit from alternative ischemic stroke prophylaxis utilizing a left atrial appendage closure (LAAC) device. Background: Patients undergoing TMVR have a high incidence of atrial fibrillation (AF). The co-morbidities which qualify them to undergo TMVR also increase their risk of stroke and bleeding, making stroke prophylaxis problematic. Methods: We conducted a single-center retrospective study, in which the bleeding and stroke risk of all patients undergoing TMVR for degenerative mitral valve disease were reviewed to determine candidacy for a LAAC device for stroke prevention as an alternative to chronic anticoagulation. Results: AF was present in 122 (62%) of TMVR patients with an average CHA2DS2-VASc score of 3.99. 23% of TMVR patients had a history of prior major bleeding event, predominately gastrointestinal bleed. Fifty-three and 47% of TMVR patients were at high or intermediate risk of bleeding, respectively, according to their HAS-BLED score. 50% of patients undergoing TMVR would qualify for LAAC device based on risk assessments. Conclusion: Patients undergoing TMVR represent a high risk group of AF patients that may benefit from a LAAC device.

Original languageEnglish (US)
Pages (from-to)274-279
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume94
Issue number2
DOIs
StatePublished - Jan 1 2019

Fingerprint

Atrial Appendage
Mitral Valve
Atrial Fibrillation
Equipment and Supplies
Population
Stroke
Hemorrhage
Retrospective Studies
Morbidity

Keywords

  • anticoagulants and antithrombins
  • bleeding
  • interventional devices and innovation
  • left atrial appendage closure
  • mitral valve disease
  • percutaneous intervention
  • transseptal catheterization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "An under-recognized high-risk atrial fibrillation population: Analyzing transcatheter mitral valve repair patients for left atrial appendage closure device application",
abstract = "Objective: Identify patients undergoing transcatheter mitral valve repair (TMVR) who could potentially benefit from alternative ischemic stroke prophylaxis utilizing a left atrial appendage closure (LAAC) device. Background: Patients undergoing TMVR have a high incidence of atrial fibrillation (AF). The co-morbidities which qualify them to undergo TMVR also increase their risk of stroke and bleeding, making stroke prophylaxis problematic. Methods: We conducted a single-center retrospective study, in which the bleeding and stroke risk of all patients undergoing TMVR for degenerative mitral valve disease were reviewed to determine candidacy for a LAAC device for stroke prevention as an alternative to chronic anticoagulation. Results: AF was present in 122 (62{\%}) of TMVR patients with an average CHA2DS2-VASc score of 3.99. 23{\%} of TMVR patients had a history of prior major bleeding event, predominately gastrointestinal bleed. Fifty-three and 47{\%} of TMVR patients were at high or intermediate risk of bleeding, respectively, according to their HAS-BLED score. 50{\%} of patients undergoing TMVR would qualify for LAAC device based on risk assessments. Conclusion: Patients undergoing TMVR represent a high risk group of AF patients that may benefit from a LAAC device.",
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