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* 1.
 

    A 75-year-old male with a history of Parkinson disease, diabetes mellitus, congestive heart failure, and permanent atrial fibrillation presents to the clinic for a regular follow up. He reports frequent mechanical falls due to the progressive worsening of his Parkinson disease. He is currently on Apixaban (Eliquis™) for anticoagulation. His blood pressure is 124/80 mm Hg, and heart rate is 88 bpm. Cardiac examination reveals S1, S2, 2/6 systolic murmur at the left lower sternal border.  A prior transesophageal echocardiogram demonstrated mild tricuspid regurgitation, enlarged left atrium, left atrial appendage ostial diameter of 24 mm and depth of 30 mm, and no evidence of thrombus or sludge. What is the next best step in the management of this patient?

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* 2. The patient has a left atrial appendage ostial diameter of 24 mm and depth greater than the width of the ostium, which is conducive for transcatheter left atrial appendage closure.  The patient has a high thromboembolic risk (CHA2DS2-VASc score > 2) with contraindication for long term oral anticoagulants.

The absence of thrombus in the left atrium and left atrial appendage is conducive for transcatheter left atrial appendage closure.  Surgical ligation of the left atrial appendage is only indicated in patients undergoing cardiac surgery.
 

  What was the major complication rate associated with Watchman Flex implantation in the PINNACLE FLEX trial? 

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* 3. Which is the appropriate test to assess left atrial appendage anatomy prior to closure of left atrial appendage by percutaneous approach.

 

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* 4. The educational activity was:

  Yes No N/A
Un-biased, free from commercial influence
Balanced and evidence-based
Effective in changing provider skills, strategies, or performance
Has the potential to improve patient outcomes

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* 5. Faculty Rating 

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* 6. Please rate the overall quality of this educational activity

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* 7. Please rate the overall impact of this educational activity on your professional practice:

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* 8. What needs to improve?

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* 9. What is your primary affiliation?

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* 10. Your information

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