Clinical Results of Left Atrial Appendage Closure with Watchman Device in Patients with Atrial Fibrillation.

BACKGROUND: In patient with non-valvular atrial fibrillation (AF), over 90% of thrombus accumulation originates in the left atrial appendage (LAA). Warfarin significantly reduces risk of stroke. However, long-term anticoagulant therapy is associated with a significant risk of major bleeding, particularly in elderly. Transcatheter occlusion of left atrial appendage with Watchman device has proved to be non-inferior to warfarin in preventing stroke in non-valvular AF patients. No previous report of transcatheter occlusion of LAA was found in Thailand OBJECTIVE: To evaluate short-term results of left atrial appendage closure with the Watchman® device in patient with non-valvular AF performed at King Chulalongkorn Memorial Hospital (KCMH). MATERIAL AND METHOD: Between November 2012 and December 2014, 12 consecutives patients underwent percutaneous transcatheter left atrial appendage closure. Data included patient's characteristics, embolic risk factors, bleeding risk score, procedural finding, complications, in-hospital outcomes, and antithrombotic management were retrospectively reviewed RESULTS: Percutaneous LAA occlusion was successfully performed in all 12 patients. The mean age was 71.2 ± 8.1 years. The history of previous bleeding was seen in four patients (33%). All patients had good left ventricular systolic function. The mean CHADS2 score was 3.2 ± 1.3, the mean CHA2DS2-VASc score was 4.8 ± 1.6 and the mean HAS-BLED score was 2.5 ± 0.9. The average LAA orifice diameter was 21.7 ± 3.4 mm, and the median implant size was 27.0 mm. The compression ratio was 15.2 ± 6.2%. Three patients (25%) were performed under general anesthesia, nine patients (75%) were performed with local anesthesia. The averageprocedure time was 61.2 ± 18.5 minutes. The average fluoroscopy time was 6.8 ± 3.3 minutes. There was no device embolization or pericardial effusion. There was no periprocedural cerebral event, assess site bleeding, or death during hospital admission. Mild peridevice leak was observed in three patients (25%), and all had disappeared on TEE performed at the 45-day follow-up. The median length of stay was two days. CONCLUSION: The result of the present study showed that percutaneous LAA occlusion with the Watchman device was feasible and safe. The successfulness of the procedures and periprocedural complications were similar to standard in literature.

Outcome of recombinant tissue plasminogen activator in ST-segment elevation myocardial infarction in Buriram Hospital.

OBJECTIVE: To study clinical outcomes of recombinant tissue plasminogen activator (alteplase) as primary fibrinolytic drug in patients with acute STEMI in Buriram Hospital. MATERIAL AND METHOD: Data on demographics, medications, in-hospital outcomes, and angiography were collected from a prospective registry of STEMI patients admitted by STEMI fast track from January 1, 2011 to December 31, 2013. RESULTS: During the 3-year period, 97 consecutive patients with STEMI who received alteplase were enrolled. The mean age was 64.3 year and 75.3% were male. There were high prevalence of dyslipidemia and current smoking. Median time from symptom onset to hospital presentation was 170 minutes. Median door to needle time was 30 minutes. Thrombolytic therapy was started in 30 minutes in 55. 7% of cases. Overall bleeding was 19.6%. Intracranial hemorrhage was 1.0% of patients. ST-segment resolution was found in 79.4% of patients. In-hospital mortality was 11.3%. Angiographic data (n = 45) in patients with clinical reperfusion (n = 32), TIMI flow grade 2 and 3 combined was 90.6% and TIMI flow grade 3 was 56.3%. Revascularization was performed in 90.6%. CONCLUSION: Alteplase in acute STEMI provided good clinical reperfusion with minimal major bleeding complication. Most of patients with clinical reperfusion required additional percutaneous coronary intervention to fix residual stenosis of infarct related artery.