The Experts below are selected from a list of 6393 Experts worldwide ranked by ideXlab platform

Vivek Y. Reddy - One of the best experts on this subject based on the ideXlab platform.

  • Left Atrial Appendage occlusion for the unmet clinical needs of stroke prevention in nonvalvular Atrial fibrillation
    Mayo Clinic Proceedings, 2019
    Co-Authors: David R Holmes, Mohamad Alkhouli, Vivek Y. Reddy
    Abstract:

    Abstract Oral anticoagulation is the dominant strategy for stroke prevention in patients with nonvalvular Atrial fibrillation. However, lifelong oral anticoagulation is associated with major issues including inappropriate dosing, nonadherence, and adverse effects. Therefore, efforts have been made to develop site-specific therapy aimed to occlude the Left Atrial Appendage, the anatomical site accountable for more than 90% of nonvalvular Atrial fibrillation–related ischemic strokes. This review focuses on the growing literature to put into perspective the risk-balance ratio of Left Atrial Appendage occlusion.

  • device related thrombus after Left Atrial Appendage closure
    Circulation, 2018
    Co-Authors: Srinivas R Dukkipati, David R Holmes, Shephal K Doshi, Vijendra Swarup, Douglas Gibson, Brijeshwar Maini, Nicole Gordon, Michael L Main, Vivek Y. Reddy
    Abstract:

    Background: In patients with Atrial fibrillation, Left Atrial Appendage closure with the Watchman device prevents thromboembolism from the Left Atrial Appendage; however, thrombus may form on the l...

  • device related thrombus after Left Atrial Appendage closure incidence predictors and outcomes
    Circulation, 2018
    Co-Authors: Srinivas R Dukkipati, David R Holmes, Shephal K Doshi, Saibal Kar, Vijendra Swarup, Douglas Gibson, Brijeshwar Maini, Nicole Gordon, Michael L Main, Vivek Y. Reddy
    Abstract:

    Background: In patients with Atrial fibrillation, Left Atrial Appendage closure with the Watchman device prevents thromboembolism from the Left Atrial Appendage; however, thrombus may form on the l...

  • original investigation5 year outcomes after Left Atrial Appendage closure from the prevail and protect af trials
    Journal of the American College of Cardiology, 2017
    Co-Authors: Vivek Y. Reddy, Petr Neuzil, Rodney Horton, Shephal K Doshi, Douglas Gibson, Nicole Gordon, Matthew J Price, Kenneth C Huber, Maurice Buchbinder, David R Holmes
    Abstract:

    Background The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that Left Atrial Appendage closure (LAAC) with the Watchman device (Boston Scientific, St. Paul, Minnesota) was equivalent to warfarin for preventing stroke in Atrial fibrillation, but had a high rate of complications. In a second randomized trial, PREVAIL (Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy), the complication rate was low. The warfarin cohort experienced an unexpectedly low ischemic stroke rate, rendering the efficacy endpoints inconclusive. However, these outcomes were based on relatively few patients followed for a relatively short time.

  • Left Atrial Appendage closure under intracardiac echocardiographic guidance feasibility and comparison with transesophageal echocardiography
    Journal of the American Heart Association, 2016
    Co-Authors: Yae Matsuo, Jan Petru, Milan Chovanec, Subbarao Choudry, Lucie Sediva, Marek Janotka, Masahiko Kurabayashi, Petr Neuzil, Jan Skoda, Vivek Y. Reddy
    Abstract:

    Background Transcatheter Left Atrial Appendage closure is an alternative therapy for stroke prevention in Atrial fibrillation patients. These procedures are currently guided with transesophageal echocardiography and fluoroscopy in most centers. As intracardiac echocardiography (ICE) is commonly used in other catheter‐based procedures, we sought to determine the safety and effectiveness of intracardiac echocardiography–guided Left Atrial Appendage closure with the Watchman device. Methods and Results A total of 27 patients (11 males, 77.0±8.5 years) with Atrial fibrillation receiving Watchman Left Atrial Appendage closure under intracardiac echocardiography guidance at a single center were investigated. All patients were implanted successfully. There were no major procedural complications. The overall procedure‐related complication rate was 14.8%, mainly due to access site hematoma. Transesophageal echocardiography demonstrated successful closure of the Left Atrial Appendage in all patients at 45 days after device implant. Conclusions Transcatheter Left Atrial Appendage closure with intracardiac echocardiography guidance is safe and feasible.

David R Holmes - One of the best experts on this subject based on the ideXlab platform.

Petr Neuzil - One of the best experts on this subject based on the ideXlab platform.

  • original investigation5 year outcomes after Left Atrial Appendage closure from the prevail and protect af trials
    Journal of the American College of Cardiology, 2017
    Co-Authors: Vivek Y. Reddy, Petr Neuzil, Rodney Horton, Shephal K Doshi, Douglas Gibson, Nicole Gordon, Matthew J Price, Kenneth C Huber, Maurice Buchbinder, David R Holmes
    Abstract:

    Background The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that Left Atrial Appendage closure (LAAC) with the Watchman device (Boston Scientific, St. Paul, Minnesota) was equivalent to warfarin for preventing stroke in Atrial fibrillation, but had a high rate of complications. In a second randomized trial, PREVAIL (Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy), the complication rate was low. The warfarin cohort experienced an unexpectedly low ischemic stroke rate, rendering the efficacy endpoints inconclusive. However, these outcomes were based on relatively few patients followed for a relatively short time.

  • Left Atrial Appendage closure under intracardiac echocardiographic guidance feasibility and comparison with transesophageal echocardiography
    Journal of the American Heart Association, 2016
    Co-Authors: Yae Matsuo, Jan Petru, Milan Chovanec, Subbarao Choudry, Lucie Sediva, Marek Janotka, Masahiko Kurabayashi, Petr Neuzil, Jan Skoda, Vivek Y. Reddy
    Abstract:

    Background Transcatheter Left Atrial Appendage closure is an alternative therapy for stroke prevention in Atrial fibrillation patients. These procedures are currently guided with transesophageal echocardiography and fluoroscopy in most centers. As intracardiac echocardiography (ICE) is commonly used in other catheter‐based procedures, we sought to determine the safety and effectiveness of intracardiac echocardiography–guided Left Atrial Appendage closure with the Watchman device. Methods and Results A total of 27 patients (11 males, 77.0±8.5 years) with Atrial fibrillation receiving Watchman Left Atrial Appendage closure under intracardiac echocardiography guidance at a single center were investigated. All patients were implanted successfully. There were no major procedural complications. The overall procedure‐related complication rate was 14.8%, mainly due to access site hematoma. Transesophageal echocardiography demonstrated successful closure of the Left Atrial Appendage in all patients at 45 days after device implant. Conclusions Transcatheter Left Atrial Appendage closure with intracardiac echocardiography guidance is safe and feasible.

  • percutaneous Left Atrial Appendage closure for stroke prophylaxis in patients with Atrial fibrillation 2 3 year follow up of the protect af watchman Left Atrial Appendage system for embolic protection in patients with Atrial fibrillation trial
    Circulation, 2013
    Co-Authors: Vivek Y. Reddy, Petr Neuzil, Shephal K Doshi, Horst Sievert, Kenneth C Huber, Maurice Buchbinder, Jonathan L Halperin, David R Holmes
    Abstract:

    Background— The multicenter PROTECT AF study (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) was conducted to determine whether percutaneous Left Atrial Appendage closure with a filter device (Watchman) was noninferior to warfarin for stroke prevention in Atrial fibrillation. Methods and Results— Patients (n=707) with nonvalvular Atrial fibrillation and at least 1 risk factor (age >75 years, hypertension, heart failure, diabetes, or prior stroke/transient ischemic attack) were randomized to either the Watchman device (n=463) or continued warfarin (n=244) in a 2:1 ratio. After device implantation, warfarin was continued for ≈45 days, followed by clopidogrel for 4.5 months and lifelong aspirin. Study discontinuation rates were 15.3% (71/463) and 22.5% (55/244) for the Watchman and warfarin groups, respectively. The time in therapeutic range for the warfarin group was 66%. The composite primary efficacy end point included stroke, systemic embolism, and cardiovascular death, and the primary analysis was by intention to treat. After 1588 patient-years of follow-up (mean 2.3±1.1 years), the primary efficacy event rates were 3.0% and 4.3% (percent per 100 patient-years) in the Watchman and warfarin groups, respectively (relative risk, 0.71; 95% confidence interval, 0.44%–1.30% per year), which met the criteria for noninferiority (probability of noninferiority >0.999). There were more primary safety events in the Watchman group (5.5% per year; 95% confidence interval, 4.2%–7.1% per year) than in the control group (3.6% per year; 95% confidence interval, 2.2%–5.3% per year; relative risk, 1.53; 95% confidence interval, 0.95–2.70). Conclusions— The “local” strategy of Left Atrial Appendage closure is noninferior to “systemic” anticoagulation with warfarin. PROTECT AF has, for the first time, implicated the Left Atrial Appendage in the pathogenesis of stroke in Atrial fibrillation. Clinical Trial Registration:— URL: . Unique identifier: [NCT00129545][1]. # Clinical Perspective {#article-title-26} [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00129545&atom=%2Fcirculationaha%2F127%2F6%2F720.atom

  • percutaneous Left Atrial Appendage closure for stroke prophylaxis in patients with Atrial fibrillation 2 3 year follow up of the protect af watchman Left Atrial Appendage system for embolic protection in patients with Atrial fibrillation trial
    Circulation, 2013
    Co-Authors: Vivek Y. Reddy, Petr Neuzil, Shephal K Doshi, Horst Sievert, Kenneth C Huber, Maurice Buchbinder, Jonathan L Halperin, David R Holmes
    Abstract:

    Background—The multicenter PROTECT AF study (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) was conducted to determine whether percutaneous Left Atrial Appendage closure with a filter device (Watchman) was noninferior to warfarin for stroke prevention in Atrial fibrillation. Methods and Results—Patients (n=707) with nonvalvular Atrial fibrillation and at least 1 risk factor (age >75 years, hypertension, heart failure, diabetes, or prior stroke/transient ischemic attack) were randomized to either the Watchman device (n=463) or continued warfarin (n=244) in a 2:1 ratio. After device implantation, warfarin was continued for ≈45 days, followed by clopidogrel for 4.5 months and lifelong aspirin. Study discontinuation rates were 15.3% (71/463) and 22.5% (55/244) for the Watchman and warfarin groups, respectively. The time in therapeutic range for the warfarin group was 66%. The composite primary efficacy end point included stroke, systemic embolism, and cardio...

  • safety of percutaneous Left Atrial Appendage closure
    Circulation, 2011
    Co-Authors: Vivek Y. Reddy, Petr Neuzil, David R Holmes, Shephal K Doshi, Saibal Kar
    Abstract:

    Background—The Watchman Left Atrial Appendage System for Embolic Protection in Patients With AF (PROTECT AF) randomized trial compared Left Atrial Appendage closure against warfarin in Atrial fibrillation (AF) patients with CHADS2 ≥1. Although the study met the primary efficacy end point of being noninferior to warfarin therapy for the prevention of stroke/systemic embolism/cardiovascular death, there was a significantly higher risk of complications, predominantly pericardial effusion and procedural stroke related to air embolism. Here, we report the influence of experience on the safety of percutaneous Left Atrial Appendage closure. Methods and Results—The study cohort for this analysis included patients in the PROTECT AF trial who underwent attempted device Left Atrial Appendage closure (n=542 patients) and those from a subsequent nonrandomized registry of patients undergoing Watchman implantation (Continued Access Protocol [CAP] Registry; n=460 patients). The safety end point included bleeding- and pro...

Shephal K Doshi - One of the best experts on this subject based on the ideXlab platform.

  • device related thrombus after Left Atrial Appendage closure
    Circulation, 2018
    Co-Authors: Srinivas R Dukkipati, David R Holmes, Shephal K Doshi, Vijendra Swarup, Douglas Gibson, Brijeshwar Maini, Nicole Gordon, Michael L Main, Vivek Y. Reddy
    Abstract:

    Background: In patients with Atrial fibrillation, Left Atrial Appendage closure with the Watchman device prevents thromboembolism from the Left Atrial Appendage; however, thrombus may form on the l...

  • device related thrombus after Left Atrial Appendage closure incidence predictors and outcomes
    Circulation, 2018
    Co-Authors: Srinivas R Dukkipati, David R Holmes, Shephal K Doshi, Saibal Kar, Vijendra Swarup, Douglas Gibson, Brijeshwar Maini, Nicole Gordon, Michael L Main, Vivek Y. Reddy
    Abstract:

    Background: In patients with Atrial fibrillation, Left Atrial Appendage closure with the Watchman device prevents thromboembolism from the Left Atrial Appendage; however, thrombus may form on the l...

  • original investigation5 year outcomes after Left Atrial Appendage closure from the prevail and protect af trials
    Journal of the American College of Cardiology, 2017
    Co-Authors: Vivek Y. Reddy, Petr Neuzil, Rodney Horton, Shephal K Doshi, Douglas Gibson, Nicole Gordon, Matthew J Price, Kenneth C Huber, Maurice Buchbinder, David R Holmes
    Abstract:

    Background The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that Left Atrial Appendage closure (LAAC) with the Watchman device (Boston Scientific, St. Paul, Minnesota) was equivalent to warfarin for preventing stroke in Atrial fibrillation, but had a high rate of complications. In a second randomized trial, PREVAIL (Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy), the complication rate was low. The warfarin cohort experienced an unexpectedly low ischemic stroke rate, rendering the efficacy endpoints inconclusive. However, these outcomes were based on relatively few patients followed for a relatively short time.

  • Left Atrial Appendage closure as an alternative to warfarin for stroke prevention in Atrial fibrillation a patient level meta analysis
    Journal of the American College of Cardiology, 2015
    Co-Authors: David R Holmes, Shephal K Doshi, Saibal Kar, Horst Sievert, Matthew J Price, Jose M Sanchez, Miguel Valderrabano, Vivek Y. Reddy
    Abstract:

    AbstractBackground: The risk-benefit ratio of Left Atrial Appendage closure (LAAC) versus systemic therapy (warfarin) for prevention of stroke, systemic embolism, and cardiovascular death in nonval...

  • percutaneous Left Atrial Appendage closure for stroke prophylaxis in patients with Atrial fibrillation 2 3 year follow up of the protect af watchman Left Atrial Appendage system for embolic protection in patients with Atrial fibrillation trial
    Circulation, 2013
    Co-Authors: Vivek Y. Reddy, Petr Neuzil, Shephal K Doshi, Horst Sievert, Kenneth C Huber, Maurice Buchbinder, Jonathan L Halperin, David R Holmes
    Abstract:

    Background— The multicenter PROTECT AF study (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) was conducted to determine whether percutaneous Left Atrial Appendage closure with a filter device (Watchman) was noninferior to warfarin for stroke prevention in Atrial fibrillation. Methods and Results— Patients (n=707) with nonvalvular Atrial fibrillation and at least 1 risk factor (age >75 years, hypertension, heart failure, diabetes, or prior stroke/transient ischemic attack) were randomized to either the Watchman device (n=463) or continued warfarin (n=244) in a 2:1 ratio. After device implantation, warfarin was continued for ≈45 days, followed by clopidogrel for 4.5 months and lifelong aspirin. Study discontinuation rates were 15.3% (71/463) and 22.5% (55/244) for the Watchman and warfarin groups, respectively. The time in therapeutic range for the warfarin group was 66%. The composite primary efficacy end point included stroke, systemic embolism, and cardiovascular death, and the primary analysis was by intention to treat. After 1588 patient-years of follow-up (mean 2.3±1.1 years), the primary efficacy event rates were 3.0% and 4.3% (percent per 100 patient-years) in the Watchman and warfarin groups, respectively (relative risk, 0.71; 95% confidence interval, 0.44%–1.30% per year), which met the criteria for noninferiority (probability of noninferiority >0.999). There were more primary safety events in the Watchman group (5.5% per year; 95% confidence interval, 4.2%–7.1% per year) than in the control group (3.6% per year; 95% confidence interval, 2.2%–5.3% per year; relative risk, 1.53; 95% confidence interval, 0.95–2.70). Conclusions— The “local” strategy of Left Atrial Appendage closure is noninferior to “systemic” anticoagulation with warfarin. PROTECT AF has, for the first time, implicated the Left Atrial Appendage in the pathogenesis of stroke in Atrial fibrillation. Clinical Trial Registration:— URL: . Unique identifier: [NCT00129545][1]. # Clinical Perspective {#article-title-26} [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00129545&atom=%2Fcirculationaha%2F127%2F6%2F720.atom

Saibal Kar - One of the best experts on this subject based on the ideXlab platform.

  • device related thrombus after Left Atrial Appendage closure incidence predictors and outcomes
    Circulation, 2018
    Co-Authors: Srinivas R Dukkipati, David R Holmes, Shephal K Doshi, Saibal Kar, Vijendra Swarup, Douglas Gibson, Brijeshwar Maini, Nicole Gordon, Michael L Main, Vivek Y. Reddy
    Abstract:

    Background: In patients with Atrial fibrillation, Left Atrial Appendage closure with the Watchman device prevents thromboembolism from the Left Atrial Appendage; however, thrombus may form on the l...

  • Left Atrial Appendage closure as an alternative to warfarin for stroke prevention in Atrial fibrillation a patient level meta analysis
    Journal of the American College of Cardiology, 2015
    Co-Authors: David R Holmes, Shephal K Doshi, Saibal Kar, Horst Sievert, Matthew J Price, Jose M Sanchez, Miguel Valderrabano, Vivek Y. Reddy
    Abstract:

    AbstractBackground: The risk-benefit ratio of Left Atrial Appendage closure (LAAC) versus systemic therapy (warfarin) for prevention of stroke, systemic embolism, and cardiovascular death in nonval...

  • latest advances in transseptal structural heart interventions percutaneous mitral valve repair and Left Atrial Appendage occlusion
    Circulation, 2014
    Co-Authors: Takashi Matsumoto, Saibal Kar
    Abstract:

    Recent advances in structural heart intervention have produced increasing demand for transseptal access, which was first introduced as a diagnostic tool to directly measure Left Atrial pressure. Transseptal access allows safe and adequate approach to the Left atrium and surrounding structures. Percutaneous transcatheter mitral valve repair using the MitraClip device is a safe and less invasive treatment for selected patients with significant mitral regurgitation, who are at high risk for surgery. This is an echocardiographic- and fluoroscopic-guided procedure requiring accurate transseptal access of the Left atrium and clipping of the mitral leaflets at the precise location of their malcoaptation. Percutaneous transcatheter closure of the Left Atrial Appendage is another novel procedure that requires transseptal access of the Left atrium, followed by closure or ligation of the Left Atrial Appendage. This catheter-based therapy has been shown to be a safe and effective alternative to long-term anticoagulant therapy for the prevention of stroke in patients with Atrial fibrillation. In this article, we systematically review these novel structural heart interventions.

  • safety of percutaneous Left Atrial Appendage closure
    Circulation, 2011
    Co-Authors: Vivek Y. Reddy, Petr Neuzil, David R Holmes, Shephal K Doshi, Saibal Kar
    Abstract:

    Background—The Watchman Left Atrial Appendage System for Embolic Protection in Patients With AF (PROTECT AF) randomized trial compared Left Atrial Appendage closure against warfarin in Atrial fibrillation (AF) patients with CHADS2 ≥1. Although the study met the primary efficacy end point of being noninferior to warfarin therapy for the prevention of stroke/systemic embolism/cardiovascular death, there was a significantly higher risk of complications, predominantly pericardial effusion and procedural stroke related to air embolism. Here, we report the influence of experience on the safety of percutaneous Left Atrial Appendage closure. Methods and Results—The study cohort for this analysis included patients in the PROTECT AF trial who underwent attempted device Left Atrial Appendage closure (n=542 patients) and those from a subsequent nonrandomized registry of patients undergoing Watchman implantation (Continued Access Protocol [CAP] Registry; n=460 patients). The safety end point included bleeding- and pro...

  • safety of percutaneous Left Atrial Appendage closure results from the watchman Left Atrial Appendage system for embolic protection in patients with af protect af clinical trial and the continued access registry
    Circulation, 2011
    Co-Authors: Vivek Y. Reddy, Petr Neuzil, David R Holmes, Shephal K Doshi, Saibal Kar
    Abstract:

    Background—The Watchman Left Atrial Appendage System for Embolic Protection in Patients With AF (PROTECT AF) randomized trial compared Left Atrial Appendage closure against warfarin in Atrial fibrillation (AF) patients with CHADS2 ≥1. Although the study met the primary efficacy end point of being noninferior to warfarin therapy for the prevention of stroke/systemic embolism/cardiovascular death, there was a significantly higher risk of complications, predominantly pericardial effusion and procedural stroke related to air embolism. Here, we report the influence of experience on the safety of percutaneous Left Atrial Appendage closure. Methods and Results—The study cohort for this analysis included patients in the PROTECT AF trial who underwent attempted device Left Atrial Appendage closure (n=542 patients) and those from a subsequent nonrandomized registry of patients undergoing Watchman implantation (Continued Access Protocol [CAP] Registry; n=460 patients). The safety end point included bleeding- and pro...