V11 - Oussama Wazni

hi

dear colleagues of the Brazilian Society of cardiology

I'm drawing by Doctor Wiseny

he's from the Cleveland Clinic in Cleveland

and he presented one very interesting trial

here at the American Hard

2024 Scientific Sessions could you summarize your um

your studies doctor wisely

thank you very much and it's an honor to

speak with our Brazilian colleagues

so option was a randomized trial

comparing left at appendage closure

to oral anticoagulation

in patients after afib ablation

and you know

I think it's an important study because after ablation

patients can have recurrence of afib

and some of it may be asymptomatic

so now

the guidelines tell us that

regardless of the result of the abolition

we should continue or discontinue

or add calegulation based on the Chad's vast score

the problem with that is that first of all

patients come you know

sometimes for an ablation

thinking that they are able to stop

or enter regulation and then

we have to explain to them

that you may have silent afib

and you shouldn't stop the or anticoagulant

on the other hand

if you have a patient who has no recurrence of afib

you keep them on anticoagulation

they don't get any benefit

but they're at risk for having bleeding

so that's why we thought well

maybe we could close the appendage

and we can mitigate this whole issue

and don't have to worry about all antiquagulence

and their side effects so

the results showed basically that Watchman Flex

was non inferior to all anticoagulation

with the composite of all cause death

stroke or systemic embolism

but it was also superior to all anticoagulation

with respect to bleeding

so the question is well okay

most of the patients now undergo ablation

so the question is if you could choose if it wasn't

if it was not for the the cost involved

do you think that most of the patients would get the

device the closure device

the Watchmen closure device

so that's a very good question

so right now what we are doing

in patients who cannot take blood thinners

because they bleed

so those are patients who are currently indicated

and watchman is right now indicated for those patients

to prevent stroke

and to avoid long term oral anticoagulation

so in those patients I think the best thing to do

if they're symptomatic with a fever

is to do an ablation and close the appendage

at the same time now

option did not look at those patients and option

the patients can take oral anti coagulation

so I think it's it'll be important for us

to discuss this with the patient

and have an important decision

dialogue and decide whether they prefer to continue

or enter cogulation or have the appendix closed

now if they have had an ablation

we can do that in a sequential way

but if they're going to get an ablation

I think then the best time to do it if they want to

have left it happens is at the same time

because we don't wanna subject them to two procedures

into different times with

the different complications that are associated with it

and it was very good results they got in their trial

the second question I have

sometimes people are worried about that the thramas

the source of the thramas may be somewhere else

other than the left atrial appendix

how about that how safe the

you know the prevention is the prevention of embolism

well in the option try

the Chad's vascular was 3.5 in both arms

and the good news was that

after three years of follow up

and this was about 800 patients in each arm

in each group after three years of follow up

the risk of stroke was very low

1.2% in the Watchmen in the device arm

versus 1.3% in the Orland coagulation arm

so I think those patients who after an ablation

the risk of stroke is is low

um and now we just have

it's a matter of preference

whether we should close the appendage or not

but I agree with you that you know

there will be a residual risk of stroke

but still it's not zero

um so the question is can you use both

so some patients may elect to get the appendage closed

and continue to or anti coagulation

and then the appendage closure is a backup

in case they need to stop anti coagulation

for example for surgery or if they have a major bleed

that needs them to stop the anti cogulation

that's very interesting idea

thank you very much for your interview

and hope to have you back in the future

I think it's very interesting

you'll have further studies right

yes we will have some more studies

thank you very much for having me

and hopefully we'll visit you once more in Brazil

thank you you're very welcome

thank you thank you very much

I love you