Evidence map›Paper›PMID 34871377›Full record

ArticleInteractive cardiovascular and thoracic surgery2022

Standalone epicardial left atrial appendage exclusion for thromboembolism prevention in atrial fibrillation.

Richard Cartledge, Grzegorz Suwalski, Anna Witkowska, Gary Gottlieb, Anthony Cioci, Gilbert Chidiac, Burak Ilsin, Barry Merrill, Piotr Suwalski

Registry-linked trialOpen access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Interactive cardiovascular and thoracic surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07705282 (Standalone Thoracoscopic Left Atrial Appendage Closure Versus Medical Therapy in Atrial Fibrillation), which is not on this map. Cited by 13 papers.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed
2.5field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07705282 nanot yet recruitingnot on this mapstarted 2028, after this paper: background citation

Standalone Thoracoscopic Left Atrial Appendage Closure Versus Medical Therapy in Atrial Fibrillation

TypeinterventionalSponsorRegion SkaneRan2028 to 2032Enrolled936ConditionsATRIAL APPENDAGE CLOSURE for ATRIAL FIBRILLATION, Oral Anticoagulation, ThoracotomyArmsVideo-assisted thoracoscopic closure of the left atrial appendage using a closure device and discontinuation of treatment if the patient is treated with OAC
3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 21 citations in OpenAlex.

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  10. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 3 countries.

Richard CartledgeCardiovascular and Thoracic Surgery, Lynn Heart and Vascular Institute Baptist Health South Florida Boca Raton Regional Hospital, Boca Raton, FL, USA.
Grzegorz SuwalskiDepartment of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland.
Anna WitkowskaDepartment of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland.ORCID 0000-0001-8188-0422
Gary GottliebCardiovascular and Thoracic Surgery, Lynn Heart and Vascular Institute Baptist Health South Florida Boca Raton Regional Hospital, Boca Raton, FL, USA.
Anthony CiociFlorida Atlantic University College of Medicine, Boca Raton, FL, USA.
Gilbert ChidiacCardiovascular and Thoracic Surgery, Lynn Heart and Vascular Institute Baptist Health South Florida Boca Raton Regional Hospital, Boca Raton, FL, USA.
Burak IlsinCardiovascular and Thoracic Surgery, Lynn Heart and Vascular Institute Baptist Health South Florida Boca Raton Regional Hospital, Boca Raton, FL, USA.
Barry MerrillCardiovascular and Thoracic Surgery, Lynn Heart and Vascular Institute Baptist Health South Florida Boca Raton Regional Hospital, Boca Raton, FL, USA.
Piotr SuwalskiDepartment of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland.ORCID 0000-0003-2670-4164
Boca Raton Regional Hospital · USCentral Clinical Hospital · PLAtlantic University College · PRWojskowy Instytut Medycyny Lotniczej · PL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesMost strokes associated with atrial fibrillation (AF) result from left atrial appendage thrombi. Oral anticoagulation can reduce stroke risk but is limited by complication risk and non-compliance. Left atrial appendage exclusion (LAAE) is a new surgical option to reduce stroke risk in AF. The study objective was to evaluate the safety and feasibility of standalone thoracoscopic LAAE in high stroke risk AF patients.

methodsThis was a retrospective, multicentre study of high stroke risk AF patients who had oral anticoagulation contraindications and were not candidates for ablation nor other cardiac surgery. Standalone thoracoscopic LAAE was performed using 3 unilateral ports access and epicardial clip. Periprocedural adverse events, long-term observational clinical outcomes and stroke rate were evaluated.

resultsProcedural success was 99.4% (174/175 patients). Pleural effusion occurred in 4 (2.3%) patients; other periprocedural complications were <1% each. One perioperative haemorrhagic stroke occurred (0.6%). No phrenic nerve palsy or cardiac tamponade occurred. Predicted annual ischaemic stroke rate of 4.8/100 patient-years (based on median CHA2DS2-VASc score of 4.0) was significantly higher than stroke risk observed in follow-up after LAAE. No ischaemic strokes occurred (median follow-up: 12.5 months), resulting in observed rate of 0 (95% CI 0-2.0)/100 patient-years (P < 0.001 versus predicted). Six all-cause (non-device-related) deaths occurred during follow-up.

conclusionsStudy proved that a new surgical option, standalone thoracoscopic LAAE, is feasible and safe. With this method, long-term stroke rate may be reduced compared to predicted for high-risk AF population.

Indexed as

Atrial AppendageAtrial FibrillationBrain IschemiaStrokeThromboembolismAnticoagulantsHumansRetrospective StudiesTreatment OutcomeAnticoagulantsAnticoagulationAtrial fibrillationClipLeft atrial appendageStrokeThoracoscopic

Identifiers

PMID34871377
PMCPMC8972304
OpenAlexW4200116757

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.