was not different than that associated with NOACs . In terms of thromboembolism , LAAO was superior to placebo and antiplatelet therapy , but again was not different than NOACs . Researchers noted there was less bleeding in the NOAC group as compared to warfarin , but there was no significant difference between warfarin and LAA occlusion . The risk of gastrointestinal ( GI ) bleeding was higher in patients taking NOACs as compared to warfarin . There was no difference in major bleeding between LAAO and placebo , antiplatelet therapy or NOAC therapy . There was less GI bleeding associated with LAAO vs . NOACs .

According to the authors , LAAO is associated with a lower risk of mortality and thromboembolism as compared to placebo or antiplatelet therapy , and is equivalent to NOAC therapy . In an ACC . org Journal Scan , Aman Chugh , MD , writes that , “ in the absence of direct comparisons between LAAO and NOACs , the authors

performed a network meta-analysis in an attempt to make indirect comparisons . The findings support the efficacy and safety profile of LAA devices . Obviously , these findings should be interpreted with caution since they were not drawn from randomized controlled trials .”

REFERENCE

Sahay S , Nombela-Franco L , Rodes-Cabau J , et al . Heart . 2016 ; doi : 10,1136 / heartjnl-2016-309782

The risk of cancer following cardiac catheterizations received during childhood is relatively low and strongly modified by survival and the type

of procedure , according to research published in Heart . However , the risk of breast cancer , especially following pulmonary artery angioplasty and valve replacements , is the greatest concern .

Data from five hospitals in the United Kingdom were used for the present analysis . A total of 2,749 procedures were used to estimate radiation doses . Monte Carlo simulations were used to examine the lifetime attributable risk ( LAR ) of cancer incidence , which was estimated using models developed by the Biological Effects of Ionizing Radiation Committee , based on both normal life expectancy , and as a function of attained age , from 20 to 80 years , to take reduced life expectancy into account .

Highest estimated radiation doses were for the lungs , esophagus and breasts . The radiation-related risks from these procedures were dominated by lung and breast cancer ( for females ). Assuming normal life expectancy , central LAR estimates for cancer

incidence , based on median doses , ranged from < 1 in 2,000 for atrial septal defect occlusions to as high as 1 in 150 for valve replacements . For a reduced life expectancy of 50 years , estimated risks were lower by a factor of around seven . For conditions with especially poor survival ( age 20 years ), such as hypoplastic left heart syndrome , estimated cancer risks attributable to radiation were < 1 in 20,000 .

Elizabeth Jackson , MD , writes in an ACC . org Journal Scan that “ treatment of childhood cardiac conditions frequently requires the need for cardiac catheterizations ; thus , in most cases , the benefits outweigh the risk .” However , she notes , that “ to reduce risk of cancer later in life , efforts to minimize radiation exposure , including duration , are warranted .” ■

REFERENCE

Harbron R , Chapple CL , O ’ Sullivan J , et al . Heart . 2016 ; doi : 10.1136 / heartjnl-2016-309773