{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:07:14Z","timestamp":1790784434480,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T00:00:00Z","timestamp":1639094400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Left atrial appendage (LAA) thrombosis increases the risk of stroke and its management has to be assessed. The aim of the present study is to evaluate short and long\u2010term safety and efficacy of a standardized approach of percutaneous LAA closure (LAAC) routinely using a cerebral protection device (CPD) in patients with LAA thrombosis or sludge (LAAT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively enrolled 14 consecutive patients with atrial fibrillation complicated by LAAT presenting in a high\u2010volume tertiary center. In seven patients (50%) LAAT was found after anticoagulant withdrawal for severe bleedings and in the remaining half LAAT was found despite appropriate anticoagulant therapy. All patients were treated with a standardized interventional approach of LAAC routinely using a CPD and guided by transoesophageal echocardiography.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean age was 68 \u00b1 14 years and nine patients (64%) were male. Mean CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc and HAS\u2010BLED scores were 3.3 \u00b1 1.6 and 2.3 \u00b1 1.1, respectively. Six patients (42.8%) presented organized thrombi while eight LAA sludge (57.1%). In 13 patients (92.8%) CPD was positioned through a right radial arterial access. Procedural success was achieved in all patients. In one patient we assisted to embolization of the thrombus during deployment of the device in the absence of neurological consequences. During a mean follow up of 426 \u00b1 307 days, one patient died for non\u2010cardiac cause while no embolic event or major bleeding were reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In an unselected cohort, LAAC with the systematic use of CPD was a feasible, safe and effective therapeutic option for LAAT both acutely and after long\u2010term follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.14398","type":"journal-article","created":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T07:28:40Z","timestamp":1638170920000},"page":"23-34","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Outcome of left atrial appendage closure using cerebral protection system for thrombosis: no patient left behind"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1600-3137","authenticated-orcid":false,"given":"Luca Rosario","family":"Limite","sequence":"first","affiliation":[{"name":"Department of Arrhythmology IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Radinovic","sequence":"additional","affiliation":[{"name":"Department of Arrhythmology IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Cianfanelli","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savino","family":"Altizio","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1815-4000","authenticated-orcid":false,"given":"Giovanni","family":"Peretto","sequence":"additional","affiliation":[{"name":"Department of Arrhythmology IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Frontera","sequence":"additional","affiliation":[{"name":"Department of Arrhythmology IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1198-9745","authenticated-orcid":false,"given":"Giuseppe","family":"D'Angelo","sequence":"additional","affiliation":[{"name":"Department of Arrhythmology IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Baratto","sequence":"additional","affiliation":[{"name":"Department of Arrhythmology IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Marzi","sequence":"additional","affiliation":[{"name":"Department of Arrhythmology IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7972-0689","authenticated-orcid":false,"given":"Francesco","family":"Ancona","sequence":"additional","affiliation":[{"name":"Unit of Cardiovascular Imaging IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Ingallina","sequence":"additional","affiliation":[{"name":"Unit of Cardiovascular Imaging IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Capogrosso","sequence":"additional","affiliation":[{"name":"Unit of Cardiovascular Imaging IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Stella","sequence":"additional","affiliation":[{"name":"Unit of Cardiovascular Imaging IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Melillo","sequence":"additional","affiliation":[{"name":"Unit of Cardiovascular Imaging IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eustachio","family":"Agricola","sequence":"additional","affiliation":[{"name":"Unit of Cardiovascular Imaging IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Della Bella","sequence":"additional","affiliation":[{"name":"Department of Arrhythmology IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizio","family":"Mazzone","sequence":"additional","affiliation":[{"name":"Department of Arrhythmology IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1995.00430050045005"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/2047487314564896"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.98.10.946"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euz257"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2017.12.008"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.07.037"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.021"},{"key":"e_1_2_9_10_1","first-page":"1208","article-title":"Percutaneous left atrial appendage closure in patients with left atrial appendage thrombus","volume":"10","author":"Meincke F","year":"2015","journal-title":"Euro Intervention Febbraio"},{"key":"e_1_2_9_11_1","first-page":"1595","article-title":"Percutaneous left atrial appendage occlusion in patients with atrial fibrillation and left appendage thrombus: feasibility, safety and clinical efficacy","volume":"13","author":"Tarantini G","year":"2018","journal-title":"Euro Intervention"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2019.11.017"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.29161"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.14246"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.08.171"},{"key":"e_1_2_9_16_1","first-page":"222","article-title":"Left atrial appendage occlusion in patients with thrombus in left atrial appendage","volume":"32","author":"Sahiner L","year":"2020","journal-title":"J Invasive Cardiol Giugno"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.009449"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2015.02.002"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)90644-0"},{"key":"e_1_2_9_20_1","article-title":"EHRA\/EAPCI expert consensus statement on catheter\u2010based left atrial appendage occlusion \u2010 an update","author":"Glikson M","year":"2019","journal-title":"Europace"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.08.016"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV12I4A84"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.4103\/0971-9784.191548"},{"key":"e_1_2_9_24_1","first-page":"1","article-title":"The COVID\u201019 challenge to cardiac electrophysiologists: optimizing resources at a referral center","volume":"18","author":"Mazzone P","year":"2020","journal-title":"J Interv Card Electrophysiol"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2018.09.018"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26677"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV8I1A8"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.11.017"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26566"},{"key":"e_1_2_9_30_1","first-page":"212","article-title":"Left atrial appendage occlusion as adjunctive therapy to Anticoagulation for stroke recurrence","volume":"31","author":"Freixa X","year":"2019","journal-title":"J Invasive Cardiol"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.14398","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.14398","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.14398","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T11:59:00Z","timestamp":1693223940000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.14398"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,10]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.1111\/pace.14398"],"URL":"https:\/\/doi.org\/10.1111\/pace.14398","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,10]]},"assertion":[{"value":"2021-03-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-31","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}