Apostolos Tzikas

Apostolos Tzikas
AHEPA University Hospital | ahepa · Department of Cardiology

MD, PhD

About

140
Publications
21,467
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
3,979
Citations
Additional affiliations
February 2015 - present
AHEPA University Hospital
Position
  • Interventional Cardiologist
October 2010 - February 2012
Montreal Heart Institute
Position
  • Clinical Fellow Structural & Congenital Heart Disease
January 2009 - December 2012
Erasmus MC
Education
October 2010 - January 2012
Montreal Heart Institute
Field of study
  • Interventional Cardiology Structural & Congenital Heart Disease
February 2009 - October 2010
Erasmus MC
Field of study
  • Interventional Cardiology

Publications

Publications (140)
Article
Patients with atrial fibrillation (AF) often receive multiple medications daily. The purpose of this study was to examine the prognostic implications of polypharmacy in patients with AF. This is a retrospective post-hoc analysis of 1,113 AF patients, enrolled in a randomized trial during an acute hospitalization (MISOAC-AF, NCT02941978). The presen...
Article
Aim: The aim of this study is to examine the association of the presence of chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) values with mortality in patients with atrial fibrillation. Methods: This posthoc analysis of a randomized controlled trial consisted of hospitalized patients with atrial fibrillation who were f...
Preprint
Introduction: Mitral annulus (MA) assessment is of utmost importance for the management of patients with mitral valve (MV) abnormalities and Three-dimensional transesophageal echocardiography (3D-TOE) has been the only reliable echocardiographic method for the evaluation of the mitral annulus by now. However, newer transthoracic echocardiography (T...
Article
Full-text available
The relationship between oral anticoagulants (OACs) and prognosis in elderly patients with atrial fibrillation (AF) has not been adequately explored. In this retrospective cohort study, we identified subjects aged over 80 from a database of 1140 AF patients discharged from the cardiology ward of a single tertiary center between 2015 and 2018. We ex...
Article
Endocardial left atrial appendage (LAA) occluders with a covering disc encompass a wide range of devices that share the common feature of a distal anchoring "body" and proximal covering "disc" design. This unique design feature has potential advantages in certain complex LAA anatomies and challenging clinical scenarios. The current review article s...
Article
AIM Education level has been long considered a life-quality modifier, but little is known about its relation to life expectancy in patients with cardiovascular disease. This study aims to assess possible correlations between education level and survival in patients with atrial fibrillation (AF). METHODS This retrospective cohort study used data fr...
Article
Background Rhythm or rate control are both commonly employed in patients with atrial fibrillation (AF) and heart failure (HF), but limited real-world data exist. We aimed to compare outcomes between the 2 strategies across the left ventricular ejection fraction (LVEF) spectrum. Materials and methods This retrospective cohort study used data from t...
Article
Aim This retrospective cohort study aimed to evaluate the prognostic implications of the distinct atrial fibrillation (AF) temporal patterns: first diagnosed, paroxysmal, and persistent or permanent AF. Methods In this post hoc analysis of the MISOAC-AF trial (NCT02941978), a total of 1052 patients with AF (median age 76 years), discharged from th...
Article
Full-text available
Background Atrial fibrillation (AF) and valvular heart disease (VHD) are frequently encountered in clinical practice, and often coexist, especially in the elderly population. Both conditions are associated with increased mortality and morbidity. Recent guidelines suggest careful evaluation of patients with AF and VHD due to the puzzling nature of t...
Article
Aims: Percutaneous left atrial appendage occlusion (LAAO) is an alternative nonpharmacological therapeutic option for stroke prevention in patients with NVAF. However, no data exist on potential LAAO candidates' prevalence among 'real-world' NVAF patients. This study aimed to investigate the indications for LAAO in hospitalized patients with comor...
Article
Full-text available
Background Valvular heart disease (VHD) in non-valvular atrial fibrillation (AF) is a puzzling clinical entity. The aim of this study was to evaluate the prognostic effect of significant VHD (sVHD) among patients with non-valvular AF. Methods This is a post-hoc analysis of the MISOAC-AF trial (NCT02941978). Consecutive inpatients with non-valvular...
Preprint
Full-text available
Purpose To assess the gender-related differences in the treatment patterns of patients with atrial fibrillation (AF), and their prognostic value. Methods In this post-hoc analysis of a randomized controlled trial, 1140 hospitalized patients with comorbid AF were followed-up for a median of 2.6 years. Kaplan-Meier and multivariable Cox-regression an...
Article
Background and objectives: Prior studies have shown that stroke patients treated with percutaneous left atrial appendage occlusion (LAAO) for non-valvular atrial fibrillation (NVAF) experience better outcomes than similar patients treated with warfarin. We investigated the impact of percutaneous left atrial appendage closure on post-stroke neurolo...
Preprint
Full-text available
Background: Valvular heart disease (VHD) in non-valvular atrial fibrillation (AF) is a puzzling clinical entity. The aim of this study was to evaluate the prognostic effect of significant VHD (sVHD) among patients with non-valvular AF. Methods: This is a post-hoc analysis of the MISOAC-AF trial (NCT02941978). Consecutive inpatients with non-valvula...
Article
Full-text available
Aims The aim of this study is to investigate the prognostic implications of the presence of heart failure (HF) across the range of left ventricular ejection fraction (LVEF) in patients with comorbid atrial fibrillation (AF). Methods and results We conducted a retrospective cohort study of 1063 patients (median age 76 years), discharged from the ca...
Article
Funding Acknowledgements Type of funding sources: None. OnBehalf MISOAC- AF study group BACKGROUND Digoxin is widely used in atrial fibrillation (AF) and heart failure (AF). However, established evidence is conflicting regarding its association with clinical outcomes. AIM To investigate the relation between digoxin and adverse outcomes in patient...
Article
Full-text available
Funding Acknowledgements Type of funding sources: None. Background Despite the plethora of studies on atrial fibrillation (AF) and diabetes mellitus (DM), there is still no sufficient data on the blood glucose regulation as a prognostic modifier in DM patients with AF. Purpose The purpose of this study was to investigate the association of DM and...
Article
Funding Acknowledgements Type of funding sources: None. Background Polypharmacy has been defined as the daily use of more than 4 drugs, by an individual, regardless of the condition(s) they have been prescribed for and their efficacy. The burden of polypharmacy pertains to adverse drug reactions, disability, frequent and longtime hospitalization a...
Article
Full-text available
Transcatheter procedures offer an alternative to cardiac surgery in select patients with structural heart disease (SHD). Unfortunately, inadvertent disruption of electrical pathways and subsequent development of new onset conduction disturbances can occur in up to 5-70% of percutaneous interventions, result in pacemaker implantation, and confer a w...
Article
Objectives To describe imaging assessment, procedural and follow‐up outcome of patients undergoing left atrial appendage (LAA) occlusion (LAAO) using a “sandwich” technique. Background The presence of a LAA with chicken wing morphology constitutes a challenge that sometimes requires specific occlusion strategies like the “sandwich” technique. Ho...
Article
Full-text available
Background: There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF). Methods: This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 20...
Article
Full-text available
Background This study sought to develop and validate a risk score for predicting mortality in patients with AF after a hospitalization for cardiac reasons. Methods The new risk score was derived by a prospective cohort of hospitalized patients with concurrent AF. The outcome measures were all-cause and cardiovascular mortality. Random forest was u...
Article
Objectives This study aimed to investigate cardiac computed tomography (CT) and transesophageal echocardiography (TEE) peridevice leak (PDL) assessments, and the clinical relevance of PDL. Background PDL assessment is integral during follow-up after left atrial appendage (LAA) occlusion. Comparative studies of TEE and cardiac CT are sparse, and th...
Preprint
Full-text available
Background: There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF). Methods: This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018....
Preprint
Full-text available
Background: There are limited data on the association of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) with outcomes in patients with atrial fibrillation (AF). Methods: This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018....
Article
Background: Atrial Fibrillation (AF) has become a major global health concern and is associated with increased risk of poor outcomes. Identifying risk factors in patients with AF can be challenging, given the high burden of comorbidities in these patients. Risk stratification schemes appear to facilitate accurate prediction of outcomes and assist t...
Article
Full-text available
Background The association of heart failure (HF) with the prognosis of atrial fibrillation (AF) remains unclear. OBJECTIVES To assess all-cause mortality in patients following hospitalization with comorbid AF in relation to the presence of HF. Methods We performed a cross-sectional analysis of data from 977 patients discharged from the cardiology...
Article
Background Oral anticoagulation (OAC) is paramount to effective thromboprophylaxis; yet adherence to OAC remains largely suboptimal in patients with atrial fibrillation (AF). Purpose We aimed to assess the impact of an educational, motivational intervention on the adherence to OAC in patients with non-valvular AF. Methods Hospitalised patients wi...
Article
Full-text available
PurposeThe present paper analyzes the role of different imaging modalities for left atrial appendage (LAA) assessment and the recommended specific measurements to improve device selection with regard to the Amulet device.Background Morphological LAA assessment is one of the pivotal factors to achieve proper LAA sealing and potentially reduce the ri...
Article
According to the latest European Society of Cardiology Guidelines for the diagnosis and management of chronic coronary syndromes (CCS), patients who suffered an acute coronary syndrome (ACS) fall into a chronic stable phase after one year. In these patients, the estimated 10-year risk for recurrent cardiovascular events varies considerably. We appl...
Article
Aims: We aimed to assess the impact of an educational, motivational intervention on the adherence to oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (AF). Methods and results: Hospitalised patients with non-valvular AF who received OAC were randomly assigned to usual medical care or a proactive intervention, comprisi...
Article
Full-text available
Patent foramen ovale (PFO) is a frequent echocardiographic finding and can be found in approximately 15-25% of the general population1 (Figure 1). The incidence of PFO is 2- to 3-fold higher in patients with stroke of undetermined etiology compared to the general population, a finding that implies a causative role of PFO in patients with stroke of...
Article
Background Prior risk stratification schemes for atrial fibrillation (AF) have extensively focused on stroke as the principal outcome. However, an accurate estimation of the risk of death in patients with AF has received disproportional attention. Purpose The aim of this study was to develop and validate a risk score for predicting mortality in pa...
Article
The rationale for the quest to close the left atrial appendage (LAA) for stroke prevention is composed of three elements: the concept that atrial fibrillation (AF) causes strokes, the concept that strokes are associated with thrombus formation in the LAA, and that these thrombi cause strokes by embolisation to the cerebral circulation. There are st...
Article
Full-text available
Scarce data are available on the effects of hospitalization on oral anticoagulation (OAC) patterns in patients with atrial fibrillation (AF). This study aimed to capture the evolving OAC patterns of patients with known non-valvular AF at high risk for stroke (CHA2DS2-Vasc score ≥ 2 for males and ≥ 3 for females) during hospitalization. A total of 5...
Article
Resumen Introducción y objetivos A pesar de la eficacia de los anticoagulantes orales (ACO), algunos pacientes mantienen una alto riesgo residual y presentan ictus aun estando en tratamiento con ACO, y falta evidencia sobre el tratamiento de estos pacientes. El objetivo del estudio es analizar la seguridad y la eficacia del cierre percutáneo de la...
Article
Background: Proper anticoagulation is a crucial therapeutic regimen in atrial fibrillation (AF). Objectives: To evaluate the real-life anticoagulation prescriptions of AF patients upon hospital discharge. Methods: We studied 768 patients with comorbid AF who were discharged from the cardiology ward of a tertiary hospital. We assessed the appro...
Article
Objectives: The aim of this study is to review the evidence on the use of antithrombotic therapy and risk of device-related thrombosis after left atrial appendage closure. Background: Left atrial appendage closure (LAAC) is increasingly performed for stroke prevention in patients with nonvalvular atrial fibrillation, especially those who cannot...
Article
Introduction and objectives: Despite the efficacy of oral anticoagulant (OAC) therapy, some patients continue to have a high residual risk and develop a stroke on OAC therapy (resistant stroke [RS]), and there is a lack of evidence on the management of these patients. The aim of this study was to analyze the safety and efficacy of left atrial appe...
Article
Full-text available
Objectives This study sought to investigate neurological disability after ischemic cerebrovascular events in patients treated with left atrial appendage (LAA) occlusion compared with those on warfarin. Background Prior studies demonstrated that cerebrovascular events after LAA occlusion in patients with nonvalvular atrial fibrillation (NVAF) is la...
Article
AMPLATZER devices preceded WATCHMAN occluder in 2002 for catheter-based left atrial appendage occlusion. The AMPLATZER technique facilitates simultaneous closure of atrial shunts using two devices through one gear. Randomized WATCHMAN follow-up data showed a mortality benefit over warfarin. AMPLATZER data make this likely valid for the strategy. Pa...
Article
Percutaneous left atrial appendage occlusion was introduced as an alternative method for prevention of thromboembolism in patients with nonvalvular atrial fibrillation after extensive animal work in 2001. The first device was named Percutaneous Left Atrial Appendage Transcatheter Occlusion (PLAATO) and patented by the company Appriva. The device wa...
Article
Major procedural complications related to left atrial appendage occlusion (LAAO) are relatively infrequent but may be associated with major morbidity and mortality. LAAO operators should be knowledgeable about these potential complications. Prompt recognition and treatment are necessary to avoid rapid deterioration and dire consequences. With strin...
Chapter
Percutaneous left atrial appendage occlusion (LAAO) is a new therapy for the prevention of systemic thromboembolism in patients with non-valvular atrial fibrillation. Currently, the most commonly used LAAO devices are the Watchman device (Boston Scientific, Natick, MA, USA) and the Amplatzer Amulet device (St Jude Medical, Plymouth, MN, USA). In th...
Article
Full-text available
It has been over a decade since dedicated Amplatzer devices have been used for left atrial appendage occlusion (LAAO) in patients with atrial fibrillation. The first was the Amplatzer Cardiac Plug (ACP) that is now replaced in most countries by the Amplatzer Amulet device. Most of the clinical data for ACP come from the ACP multicenter registry tha...
Chapter
The left atrial appendage (LAA) is a highly variable, delicate cardiac structure. A transseptal puncture is needed in order to perform percutaneous LAA closure and, being a blind-ended structure, the LAA cannot be accessed with over-the-wire techniques. The LAA is part of the left heart circulation so embolization of thrombi, air or other material...
Chapter
The Amplatzer Amulet is a nitinol wire mesh self-expanding device shaped into a distal lobe and a proximal disc, which are connected by a flexible waist. The lobe of the device has 6–10 pairs of stabilizing wires and is implanted in the proximal 10–15 mm of the left atrial appendage (LAA), whereas the disc of the device is intended to cover its atr...
Chapter
The Amplatzer Amulet has a different implantation technique to that of the Wathcman device as it has a two-part self expanding distal lobe and proximal disc. The proximal disk needs to have a concave shape to ensure adequate sealing and prevent device thrombosis. This requires the distal lobe to be deep in the LAA. Several techniques have been deve...
Article
History of major gastrointestinal (GI) bleeding may represent a frequent clinical indication for left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (AF). This study aims to investigate the procedural safety and long-term outcome of patients with previous major GI bleeding (MGIB) undergoing LAAO. Data from the A...
Article
Objectives: This study aimed to provide a systematic review of device-associated thrombosis (DAT) after left atrial appendage occlusion (LAAO) with the Watchman, Amplatzer Cardiac Plug, and Amulet devices. Background: DAT is known as a complication of LAAO but data about its clinical impact is scarce. Methods: A systematic review of studies ev...
Article
Background: In patients with non-valvular atrial fibrillation (NVAF), intracranial bleeding (ICB) constitutes a very challenging situation in which the rate of both ischemic and hemorrhagic events is increased. In these patients, left atrial appendage occlusion (LAAO) might represent a very valid alternative. Objectives: To investigate the proce...
Article
Objectives: Routine device surveillance after successful left atrial appendage closure is recommended to evaluate for intermediate to late complications. The aim of this study was to assess the incidence and clinical impact of these complications on cardiovascular events. Methods: Centers participating in the Amplatzer Cardiac Plug multicenter s...
Book
This concise practical guide is designed to facilitate the clinical decision-making process in the management of LAA occlusion procedures by reviewing a number of cases and defining the various diagnostic and management decisions open to clinicians. Clinical Cases in LAA Occlusion is well illustrated but concise, enabling the reader to obtain rele...
Article
Aims: Correct sizing of a left atrial appendage (LAA) closure system is important to avoid redeployment of the device and peri-device leaks. The aims of this study were to assess the significance of two-dimensional transoesophageal echocardiography (2D-TEE), real-time 3D transoesophageal echocardiography (RT 3D-TEE) and angiography for measuring th...
Article
Full-text available
Chronic thromboembolic pulmonary hypertension (CTEPH) is the only potentially curable cause of pulmonary hypertension. Pulmonary thromboendarterectomy (PEA) is an established therapy for CTEPH in expert centers. Balloon pulmonary angioplasty (BPA) is an adjunctive therapeutic option for patients with inoperable or residual disease after PEA, as wel...
Article
Cardio-embolic strokes are generally more lethal and disabling than other source of strokes. Data from PROTECT-AF suggest that strokes after left atrial appendage occlusion (LAAO) with the Watchman device are less disabling than those in the warfarin group. No data assessing the severity of strokes after LAAO with the Amplatzer Cardiac Plug (ACP) a...
Article
The increasing interest in left atrial appendage occlusion (LAAO) for ischaemic stroke prevention in atrial fibrillation (AF) fuels the need for more clinical data on the safety and effectiveness of this therapy. Besides an assessment of the effectiveness of the therapy in specific patients groups, comparisons with pharmacological stroke prophylaxi...
Article
Full-text available
The Portico system (St. Jude Medical, Minneapolis, MN, USA) consists of a self-expanding valve prosthesis and a delivery system designed for transcatheter aortic valve replacement (TAVR). We describe this system, its 10-steps implantation procedure, and provide tips and tricks based on our personal experience with this system.
Conference Paper
AIMS Routine device surveillance after successful left atrial appendage (LAA) closure is recommended to evaluate for intermediate­late complications. We sought to assess the incidence and clinical impact of these complications on cardiovascular events. METHODS AND RESULTS Centres participating in the Amplatzer Cardiac Plug (ACP) multicenter study w...
Article
Full-text available
Left atrial appendage closure (LAAC), a device-based therapy for stroke prevention in patients with atrial fibrillation, is considered an alternative to oral anticoagulation therapy, particularly for patients at high risk of bleeding. Proof of concept has been demonstrated by the PROTECT AF and PREVAIL trials which evaluated the WATCHMAN device (Bo...