Left Atrial Appendages Occlusion: Current Status and Prospective

Overview

Journal Korean Circ J

Date 2018 Aug 4

PMID 30073807

Citations 10

Authors

Sharan Prakash Sharma

Peter Park

Dhanunjaya Lakkireddy

Affiliations

Soon will be listed here.

Abstract

Stroke continues to be a major cause of morbidity and mortality in atrial fibrillation (AF) patients. Oral anticoagulation (OAC) provides protection against stroke and peripheral embolization in AF but significant proportion of patients could not be started on anticoagulation because of bleeding complications. Left atrial appendage harbors clot in about 90% of nonvalvular AF. The advent of left atrial appendage occlusion (LAAO) techniques has provided these patients with alternative to OAC for stroke prophylaxis. Multiple LAAO devices are currently available with Watchman and Amulet being the most commonly used in clinical practice. Randomized studies are available for Watchman device only. Data on Amplatzer Cardiac Plug, Amulet and Lariat devices are limited by the paucity of randomized data. Long-term data on different LAAO techniques are showing promising results. Device related thrombosis continues to be a serious complication associated with LAAO. Future studies should look into comparative effectiveness between different LAAO techniques, optimal patient selection, risk of complications, and anticoagulant treatment after LAAO. This article aims to provide current available evidence on efficacy and safety of different LAAO devices and future prospective.

Citing Articles

Prognostic Value of Galectin-3 after Left Atrial Appendage Occlusion for Predicting Peri-Device Leakage.

Haertel F, Lustermann P, Hamadanchi A, Gruen K, Bogoviku J, Aftanski P Int J Mol Sci. 2023; 24(23).

PMID: 38069127 PMC: 10705923. DOI: 10.3390/ijms242316802.

Left Atrial Appendage Occlusion versus Novel Oral Anticoagulation for Stroke Prevention in Atrial Fibrillation-One-Year Survival.

Tiosano S, Banai A, Mulla W, Goldenberg I, Bayshtok G, Amit U J Clin Med. 2023; 12(20).

PMID: 37892833 PMC: 10607551. DOI: 10.3390/jcm12206693.

Long-Term Effect of Left Atrial Appendage Occlusion in Treating Patients with Previous Ischemic Stroke on the Disease Recurrence.

Yu J, Liu Y, Sun P, Guo X, Jiang H, Fang W Comput Math Methods Med. 2021; 2021:6991002.

PMID: 34691240 PMC: 8528575. DOI: 10.1155/2021/6991002.

Demonstration of proof-of-concept of StrokeShield system for complete closure and occlusion of the left atrial appendage for non-valvular atrial fibrillation therapy.

Slaughter M, Monreal G, Koenig S, Giridharan G, Tompkins L, Jimenez J PLoS One. 2021; 16(6):e0253299.

PMID: 34157041 PMC: 8219146. DOI: 10.1371/journal.pone.0253299.

Cardioform Septal Occluder for the Closure of a Peri-Device Leak After Initial Watchman Implantation.

Sleiman J, Lewis A, Perez E, Asher C, Cubeddu R Cureus. 2021; 13(6):e15439.

PMID: 34113525 PMC: 8177093. DOI: 10.7759/cureus.15439.

References

Mant J, Hobbs F, Fletcher K, Roalfe A, Fitzmaurice D, Lip G . Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007; 370(9586):493-503. DOI: 10.1016/S0140-6736(07)61233-1. View

Urena M, Rodes-Cabau J, Freixa X, Saw J, Webb J, Freeman M . Percutaneous left atrial appendage closure with the AMPLATZER cardiac plug device in patients with nonvalvular atrial fibrillation and contraindications to anticoagulation therapy. J Am Coll Cardiol. 2013; 62(2):96-102. DOI: 10.1016/j.jacc.2013.02.089. View

Onalan O, Crystal E . Left atrial appendage exclusion for stroke prevention in patients with nonrheumatic atrial fibrillation. Stroke. 2007; 38(2 Suppl):624-30. DOI: 10.1161/01.STR.0000250166.06949.95. View

Gloekler S, Shakir S, Doblies J, Khattab A, Praz F, Guerios E . Early results of first versus second generation Amplatzer occluders for left atrial appendage closure in patients with atrial fibrillation. Clin Res Cardiol. 2015; 104(8):656-65. DOI: 10.1007/s00392-015-0828-1. View

Santoro G, Meucci F, Stolcova M, Rezzaghi M, Mori F, Palmieri C . Percutaneous left atrial appendage occlusion in patients with non-valvular atrial fibrillation: implantation and up to four years follow-up of the AMPLATZER Cardiac Plug. EuroIntervention. 2014; 11(10):1188-94. DOI: 10.4244/EIJY14M10_13. View

Boersma L, Schmidt B, Betts T, Sievert H, Tamburino C, Teiger E . Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry. Eur Heart J. 2016; 37(31):2465-74. PMC: 4996118. DOI: 10.1093/eurheartj/ehv730. View

Savelieva I, Camm J . Update on atrial fibrillation: part I. Clin Cardiol. 2008; 31(2):55-62. PMC: 6653415. DOI: 10.1002/clc.20138. View

Lopez Minguez J, Asensio J, Elduayen Gragera J, Costa M, Cruz Gonzalez I, Gimeno de Carlos F . Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure. Heart. 2015; 101(11):877-83. DOI: 10.1136/heartjnl-2014-306332. View

Tzikas A, Shakir S, Gafoor S, Omran H, Berti S, Santoro G . Left atrial appendage occlusion for stroke prevention in atrial fibrillation: multicentre experience with the AMPLATZER Cardiac Plug. EuroIntervention. 2015; 11(10):1170-9. DOI: 10.4244/EIJY15M01_06. View

10.

Enomoto Y, Gadiyaram V, Gianni C, Horton R, Trivedi C, Mohanty S . Use of non-warfarin oral anticoagulants instead of warfarin during left atrial appendage closure with the Watchman device. Heart Rhythm. 2016; 14(1):19-24. DOI: 10.1016/j.hrthm.2016.10.020. View

11.

Lee O, Kim J, Pak H, Hong G, Shim C, Uhm J . Feasibility of Left Atrial Appendage Occlusion for Left Atrial Appendage Thrombus in Patients With Persistent Atrial Fibrillation. Am J Cardiol. 2018; 121(12):1534-1539. DOI: 10.1016/j.amjcard.2018.02.045. View

12.

Lakkireddy D, Turagam M, Afzal M, Rajasingh J, Atkins D, Dawn B . Left Atrial Appendage Closure and Systemic Homeostasis: The LAA HOMEOSTASIS Study. J Am Coll Cardiol. 2018; 71(2):135-144. DOI: 10.1016/j.jacc.2017.10.092. View

13.

Starck C, Steffel J, Emmert M, Plass A, Mahapatra S, Falk V . Epicardial left atrial appendage clip occlusion also provides the electrical isolation of the left atrial appendage. Interact Cardiovasc Thorac Surg. 2012; 15(3):416-8. PMC: 3422917. DOI: 10.1093/icvts/ivs136. View

14.

Badhwar N, Lakkireddy D, Kawamura M, Han F, Iyer S, Moyers B . Sequential Percutaneous LAA Ligation and Pulmonary Vein Isolation in Patients with Persistent AF: Initial Results of a Feasibility Study. J Cardiovasc Electrophysiol. 2015; 26(6):608-14. DOI: 10.1111/jce.12655. View

15.

Pillarisetti J, Reddy Y, Gunda S, Swarup V, Lee R, Rasekh A . Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices: Understanding the differences in the location and type of leaks and their clinical implications. Heart Rhythm. 2015; 12(7):1501-7. DOI: 10.1016/j.hrthm.2015.03.020. View

16.

Kleinecke C, Park J, Godde M, Zintl K, Schnupp S, Brachmann J . Twelve-month follow-up of left atrial appendage occlusion with Amplatzer Amulet. Cardiol J. 2017; 24(2):131-138. DOI: 10.5603/CJ.a2017.0017. View

17.

Koskinas K, Shakir S, Fankhauser M, Nietlispach F, Attinger-Toller A, Moschovitis A . Predictors of Early (1-Week) Outcomes Following Left Atrial Appendage Closure With Amplatzer Devices. JACC Cardiovasc Interv. 2016; 9(13):1374-83. DOI: 10.1016/j.jcin.2016.04.019. View

18.

Regueiro A, Bernier M, OHara G, OConnor K, Paradis J, Beaudoin J . Left atrial appendage closure: Initial experience with the ultraseal device. Catheter Cardiovasc Interv. 2016; 90(5):817-823. DOI: 10.1002/ccd.26870. View

19.

Genovesi S, Slaviero G, Porcu L, Casu G, Bertoli S, Sagone A . Implant success and safety of left atrial appendage occlusion in end stage renal disease patients: Peri-procedural outcomes from an Italian dialysis population. Int J Cardiol. 2018; 262:38-42. DOI: 10.1016/j.ijcard.2018.03.083. View

20.

Reddy V, Doshi S, Kar S, Gibson D, Price M, Huber K . 5-Year Outcomes After Left Atrial Appendage Closure: From the PREVAIL and PROTECT AF Trials. J Am Coll Cardiol. 2017; 70(24):2964-2975. DOI: 10.1016/j.jacc.2017.10.021. View