A novel device for left atrial appendage exclusion: The third-generation atrial exclusion device

Fumoto, Hideyuki; Gillinov, A. Marc; Ootaki, Yoshio; Akiyama, Mitoshi; Saeed, Diyar; Horai, Tetsuya; Ootaki, Chiyo; Vince, D. Geoffrey; Popović, Zoran B.; Dessoffy, Raymond; Massiello, Alex; Catanese, Jacquelyn; Fukamachi, Kiyotaka

doi:10.1016/j.jtcvs.2008.06.002

Cited by 49 publications

(36 citation statements)

References 20 publications

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“…It is designed to be implanted from outside the heart through a thoracoscopic approach. 4 In January 2010, the patient underwent the thoracoscopic procedure under general anesthesia with dual-lumen intubation. Three ports were positioned: 1 (5 mm) in the third intercostal space, 1 (10 mm) in the sixth space at the median axillary level, and 1 (10 mm) in the fifth space on the posterior axillary line.…”

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confidence: 99%

Thoracoscopic Appendage Exclusion With an Atriclip Device As a Solo Treatment for Focal Atrial Tachycardia

Benussi¹,

Mazzone²,

Maccabelli³

et al. 2011

Circulation

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A 15-year-old boy with incessant drug-refractory atrial tachycardia was referred to our department for an ablation procedure. The tachycardia was diagnosed at 13 years of age during routine medical screening for soccer competition. Despite the administration of metoprolol, verapamil, and flecainide, the arrhythmia persisted and ventricular response was not controlled. Physical examination was normal except for a heart rate of 130 bpm; no signs of congestive heart failure were found.Blood examinations revealed normal thyroid function. Twelve-lead ECG showed a narrow QRS tachycardia with positive P waves in II-III-aVF-V1-V2 leads, negative P waves in I-aVL leads, and a short PR interval (Figure 1), suggesting a left atrial origin. 1,2 Transthoracic echocardiography showed normal left ventricular size with normal systolic function and normal atrial volumes.During electrophysiological study, the earliest atrial activation during tachycardia was located on the distal bipole of the coronary sinus catheter, confirming a lateral left atrial origin. 1-3 Left atrial access was obtained by transseptal approach with a Brockenbrough needle. Electroanatomic mapping, performed with the CARTO 3 mapping system (Biosense-Webster Diamond Bar, CA), showed a normal left atrial morphology and an eccentric atrial activation from the distal portion of the left atrial appendage (Figure 2). [1][2][3] Radiofrequency was delivered at the site where the earliest local electrogram preceded atrial activation on the distal coronary sinus by 48 milliseconds. However, tachycardia relapsed despite 2 percutaneous ablation attempts (Figure 3).To eliminate the arrhythmia, epicardial exclusion of the appendage with a minimally invasive occlusion device (Atriclip, AtriCure Inc) was decided. The clip is composed of 2 parallel, straight, rigid titanium tubes covered with a knitbraided polyester sheath. It is designed to be implanted from outside the heart through a thoracoscopic approach. 4 In January 2010, the patient underwent the thoracoscopic procedure under general anesthesia with dual-lumen intubation. Three ports were positioned: 1 (5 mm) in the third intercostal space, 1 (10 mm) in the sixth space at the median axillary level, and 1 (10 mm) in the fifth space on the posterior axillary line. Pericardiotomy was performed parallel and posterior to the phrenic pedicle to expose the left atrial Figure 1. Twelve-lead ECG showed a narrow QRS tachycardia with positive P waves in II-III-aVF-V1-V2 leads, negative P waves in I-aVL leads, and a short PR interval, suggesting a left atrial origin.

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confidence: 99%

Thoracoscopic Appendage Exclusion With an Atriclip Device As a Solo Treatment for Focal Atrial Tachycardia

Benussi¹,

Mazzone²,

Maccabelli³

et al. 2011

Circulation

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“…The AtriClip (Atricure, West Chester, Ohio) consists of 2 parallel titanium tubes and 2 nitinol springs with a knit-braided polyester fabric 31 delivered with a deployment tool consisting of a distal articulating head connected to a shaft and proximal actuator. The Food and Drug Administration (FDA) approval states that it is indicated for LAA occlusion under direct visualization, in conjunction with other open cardiac surgical procedures.…”

Section: Surgical Laa Exclusion and Excisionmentioning

confidence: 99%

Left Atrial Appendage Closure to Prevent Stroke in Patients With Atrial Fibrillation

Price

Valderrábano

2014

Circulation

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“…Recently, a new clip device was introduced and tested in animals and patients. 20,21 The initial results are favorable, and further trials are required to test the longterm safety and to evaluate the role of left atrial appendage occlusion in the prevention of stroke.…”

Section: Minimally Invasive Surgery For Lone Atrial Fi Brillationmentioning

confidence: 99%

Surgery for atrial fibrillation: recent progress and future perspective

Nitta

Ishii

Sakamoto

2012

Gen Thorac Cardiovasc Surg

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Development and introduction of radiofrequency ablation devices allowed the maze procedures to be performed safely and easily, further enabling off-pump pulmonary vein isolation through a mini-thoracotomy or thoracoscope. The effects of the maze procedure include prevention of stroke and other complications related to atrial fibrillation, improved cardiac performance, and relief of symptoms. Indications for the maze procedure have been discussed on the basis of the evidence. Pulmonary vein isolation has been shown to be effective in most patients with paroxysmal atrial fibrillation and can be performed with endocardial catheter ablation and minimally invasive epicardial ablation. These two modalities should be compared in terms of the success rate, occurrence of cerebral microembolic signals, capability of additional lesions indicated for persistent or long-standing persistent atrial fibrillation, and closure of the left atrial appendage. Noncontinuous or nontransmural lines of conduction block as a result of incomplete ablation can result in recurrence of atrial fibrillation and induction of atrial tachycardia. Intraoperative verification of conduction block across the ablation lines is recommended to prevent these complications. Volume reduction of the enlarged left atrium or a boxlesion to isolate the entire posterior left atrium may be effective in patients with a dilated left atrium, but the potentially impaired atrial transport function should be considered. Mapping of active ganglionated plexi and their ablation may improve the outcome of the procedure, but the long-term effect on atrial fibrillation and autonomic nerve activities should be examined.

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A novel device for left atrial appendage exclusion: The third-generation atrial exclusion device

Cited by 49 publications

References 20 publications

Thoracoscopic Appendage Exclusion With an Atriclip Device As a Solo Treatment for Focal Atrial Tachycardia

Thoracoscopic Appendage Exclusion With an Atriclip Device As a Solo Treatment for Focal Atrial Tachycardia

Left Atrial Appendage Closure to Prevent Stroke in Patients With Atrial Fibrillation

Surgery for atrial fibrillation: recent progress and future perspective

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