Publications by authors named "Jens Erik Nielsen Kudsk"
Article Synopsis
- Many patients with atrial fibrillation (AF) are not receiving or are stopping oral anticoagulation therapy, despite its importance for stroke prevention.
- While direct oral anticoagulants (DOACs) are available, issues like bleeding risks, poor compliance, and aversion to treatment contribute to this problem.
- A recent expert consensus guide highlights left atrial appendage closure (LAAC) as a safe alternative for stroke prevention in patients who cannot use long-term anticoagulation, detailing the devices, implantation technique, and follow-up requirements for non-implanting physicians.
Introduction And Objectives: The optimal antithrombotic therapy (AT) after left atrial appendage closure (LAAC) is debated. We assessed the impact of intensive vs nonintensive AT on the incidence of device-related thrombus (DRT) based on whether the device implantation was classified as optimal or suboptimal.
Methods: This study included patients who underwent successful LAAC in 9 centers.
Background: The Amulet IDE trial (AMPLATZER Amulet Left Atrial Appendage Occluder [LAAO] Investigational Device Exemption [IDE] Trial) evaluated the safety and effectiveness of the Amulet occluder (Abbott) in patients with nonvalvular atrial fibrillation. The Amulet IDE trial is the largest randomized LAAO trial, comparing the Amulet occluder with the Watchman 2.5 device (Boston Scientific).
View Article and Find Full Text PDFBackground: Oral anticoagulation is recommended after ablation for atrial fibrillation among patients at high risk for stroke. Left atrial appendage closure is a mechanical alternative to anticoagulation, but data regarding its use after atrial fibrillation ablation are lacking.
Methods: We conducted an international randomized trial involving 1600 patients with atrial fibrillation who had an elevated score (≥2 in men and ≥3 in women) on the CHADS-VASc scale (range, 0 to 9, with higher scores indicating a greater risk of stroke) and who underwent catheter ablation.
Background: Device-related thrombosis (DRT) occurs in up to 4% of patients undergoing left atrial appendage occlusion (LAAO) and is associated with substantial morbidity and mortality. However, its pathophysiology, predictors, and optimal management remain unclear.
Objectives: This study aims to assess flow dynamic factors correlating to DRT.
Article Synopsis
- Chronic thromboembolic pulmonary hypertension (CTEPH) causes right ventricular dysfunction due to increased pressure in the lungs, and this study focuses on the relationship between RV to pulmonary artery coupling and invasive heart measurements.
- A cohort of 139 CTEPH patients was studied, showing a significant correlation between the echocardiographic TAPSE/PASP ratio and pulmonary vascular resistance, with improvements in this ratio following treatments like BPA and PEA.
- The findings suggest that the TAPSE/PASP ratio can be a useful tool for monitoring treatment outcomes in CTEPH patients, though further research is needed to determine its prognostic value and influence on treatment decisions.
Article Synopsis
- Patients with a heart condition called atrial fibrillation (AF) who have strokes can still be at very high risk of having more strokes, even when taking medication to prevent them.
- Left atrial appendage occlusion (LAAO) is a special procedure aimed at helping these patients avoid future strokes.
- A study compared two groups – one that had LAAO and one that only continued their usual medication – and found that there was still a risk of strokes in both groups over a two-year period.
Background: Transcatheter patent foramen ovale (PFO) closure is the recommended treatment for patients age 18 to 60 years with cryptogenic stroke having a high probability of being PFO-related. Limited data exist on stroke recurrence after PFO closure outside clinical trials.
Objectives: The purpose of this study was to examine stroke recurrence after PFO closure in routine clinical practice.
Acute pulmonary embolism (PE) is a potentially life-threatening condition that causes abrupt obstruction of the pulmonary arteries, leading to acute right heart failure. Novel diagnostic methods and catheter-directed therapies are being developed rapidly, and there is an obvious need for a realistic PE animal model that can be used for pathophysiological evaluation and preclinical testing. This protocol introduces a porcine model employing large autologous pulmonary emboli.
View Article and Find Full Text PDFReproducibility of cardiac computed tomography classifications of hypoattenuated thickening and peridevice leak following left atrial appendage closure.
Eur Heart J Cardiovasc Imaging
December 2024
Article Synopsis
- The study aimed to evaluate the consistency of interpreting cardiac CT scans for hypoattenuated thickening (HAT) and peridevice leak (PDL) after left atrial appendage closure (LAAC) with the Watchman FLX device.
- In a multicenter study involving 100 anonymized CT scans, both an experienced and a novice rater independently assessed readings, showing substantial agreement, particularly in identifying high-grade HAT and distal patency, while some specific measures proved less reliable.
- The conclusion indicates that even with minimal training, high inter- and intra-rater reliability was achieved for most interpretations, suggesting that future research will further investigate the implications of these findings.
Background: Patent foramen ovale (PFO) has been associated with ischemic stroke and transient ischemic attack (TIA). Guidelines recommend PFO closure for stroke prevention in selected patients, but the risk of recurrent stroke remains high compared to the background population. We aimed to evaluate the causes of recurrent stroke/TIA and post-interventional complications in patients after PFO closure.
View Article and Find Full Text PDFArticle Synopsis
- Left atrial appendage occlusion (LAAO) is becoming an important method for preventing strokes in patients with atrial fibrillation, with cardiac imaging being crucial for planning and follow-up.
- Recent advancements in cardiac computed tomography (CCT) have made it a preferred option over transesophageal echocardiography for assessing LAAO procedures, particularly in identifying device-related complications.
- This paper aims to standardize how to acquire and interpret CCT images after LAAO, addressing current inconsistencies and providing guidance based on expert consensus from specialists in Europe and North America.
Article Synopsis
- Device-related thrombosis (DRT) occurs frequently after left atrial appendage closure (LAAC), with notable differences in diagnosis timing and outcomes between men and women.
- Women make up 34.7% of DRT patients in the study and tend to be older and have fewer comorbidities compared to men, but DRT in women is diagnosed significantly later.
- Both genders have similar treatment outcomes and overall mortality rates, indicating that treatment strategies are equally effective regardless of sex.
Understanding the role of the left atrial appendage on the flow in the atrium.
Catheter Cardiovasc Interv
November 2024
Article Synopsis
- The study investigates the impact of excluding the left atrial appendage (LAA) on blood flow dynamics in patients with atrial fibrillation, who are at risk of stroke and bleeding.
- Computational fluid dynamics simulations were performed for nine patients, analyzing various flow parameters before and after LAA exclusion.
- Results indicated a significant decrease in Time Averaged Wall Shear Stress and low-magnitude velocities, alongside slight increases in Oscillatory Shear Index, Relative Residence Time, and pressure; further research is needed to understand the clinical significance of these changes.
Different rat strains are used in various animal models of pulmonary hypertension and right ventricular (RV) failure. No systematic assessment has been made to test differences in RV response to pressure overload between rat strains. We compared RV adaptation to pulmonary trunk banding (PTB) in Wistar (W), Sprague Dawley (SD), and Fischer344 (F) rats by hemodynamic profiling focusing on diastolic function.
View Article and Find Full Text PDFBackground: Left atrial appendage occlusion (LAAO) is performed increasingly, but long-term follow-up imaging data are lacking.
Aims: The aim of this study was to evaluate the safety and durability of the Amplatzer Amulet device >4 years after LAAO.
Methods: This was a prospective observational cohort study including 52 patients implanted with the Amplatzer Amulet device at Aarhus University Hospital, Denmark.
Article Synopsis
- Left atrial appendage occlusion (LAAO) is a treatment for patients with atrial fibrillation (AF) who can't use oral anticoagulation therapy (OAT) and those who face recurring thrombotic events despite OAT.
- This study compared the efficacy of LAAO in patients experiencing thrombotic events while on OAT against those who had contraindications for OAT, using data from a large registry and propensity score matching for accuracy.
- Results showed no significant difference in ischemic stroke rates between the two groups, but the LAAO patients on OAT had a higher thromboembolic risk but lower bleeding risk, suggesting LAAO is a viable option for these patients.
Background: Acute pulmonary embolism (PE) induces ventilation-perfusion mismatch and hypoxia and increases pulmonary pressure and right ventricular (RV) afterload, entailing potentially fatal RV failure within a short timeframe. Cardiopulmonary factors may respond differently to increased clot burden. We aimed to elucidate immediate cardiopulmonary responses during successive PE episodes in a porcine model.
View Article and Find Full Text PDFBackground: Device-related thrombosis (DRT) is a known complication to left atrial appendage closure (LAAC). The surface of a LAAC device should ideally have antithrombotic properties. The novel WATCHMAN FLX Pro (WFP) incorporates a fluoropolymer-coated fabric membrane designed to increase thromboresistance and facilitate endothelialization.
View Article and Find Full Text PDFObjectives: To investigate the contribution of mechanical obstruction and pulmonary vasoconstriction to pulmonary vascular resistance (PVR) in acute pulmonary embolism (PE) in pigs.
Design: Controlled, animal study.
Setting: Tertiary university hospital, animal research laboratory.
Background: The optimal antithrombotic therapy following left atrial appendage occlusion (LAAO) remains debated. Ideally, this therapy should effectively prevent device-related thrombosis (DRT) while minimising the associated bleeding risk.
Aims: We aimed to evaluate the long-term safety and efficacy of a postprocedural single antiplatelet therapy (SAPT) strategy following Amplatzer LAAO in a large consecutive cohort.
Left atrial appendage occlusion (LAAO) is an established alternative to oral anticoagulation for stroke prevention in atrial fibrillation. Antithrombotic therapy is used in the post-procedural period to prevent device-related thrombosis (DRT). The risk of DRT is considered highest in the first 45-90 days after device implantation, based on animal studies of the device healing process.
View Article and Find Full Text PDFA significant proportion of patients who suffer from atrial fibrillation (AF) and are in need of thromboembolic protection are not treated with oral anticoagulation or discontinue this treatment shortly after its initiation. This undertreatment has not improved sufficiently despite the availability of direct oral anticoagulants which are associated with less major bleeding than vitamin K antagonists. Multiple reasons account for this, including bleeding events or ischaemic strokes whilst on anticoagulation, a serious risk of bleeding events, poor treatment compliance despite best educational attempts, or aversion to drug therapy.
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