Evidence-Based Percutaneous Closure of the Left Atrial Appendage in Patients with Atrial Fibrillation

Leal, Sílvio; Moreno, Raúl; Almeida, Manuel; Silva, José Aniceto; López‐Sendón, José

doi:10.2174/157340312801215827

Cited by 9 publications

(9 citation statements)

References 65 publications

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“…In most literature, the LAA was described as “a long, tubular, hooked structure” of variable morphology and size[ 9 , 13 , 27 – 32 ]. However, our study detected substantially variable morphologies of the LAA.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the most established prophylaxis for stroke in atrial fibrillation is the dose-modulated oral anticoagulation with vitamin-K-antagonists, with warfarin being the most widely investigated drug[ 11 ]. Of note, it is often difficult to maintain long-term anticoagulation within a narrow therapeutic range partly because of regular laboratory monitoring of anticoagulation intensity, frequent dose adjustment and higher risks of bleeding during anticoagulation [ 13 , 14 ]. Patients with atrial fibrillation, high risk of stroke and contraindications to long-term oral administration of anticoagulants due to hemorrhage or other secondary adverse effects may be candidates for alternative treatment that combines high efficacy in stroke prevention and low hemorrhage risk.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative Evaluation of the Substantially Variable Morphology and Function of the Left Atrial Appendage and Its Relation with Adjacent Structures

Gao

Liu

et al. 2015

PLoS ONE

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ObjectiveTo investigate quantitatively the morphology, anatomy and function of the left atrial appendage (LAA) and its relation with adjacent structures.Materials and MethodsA total of 860 patients (533 men, 62.0%, age 55.9±10.4 year) who had cardiac multidetector computed tomography angiography from May to October 2012 were enrolled for analysis.ResultsSeven types and 6 subtypes of LAA morphology were found with Type 2 being the most prevalent. Type 5 was more significantly (P<0.05) present in women (8.0%) than in men (4.2%). LAA orifice was oval in 81.5%, triangular in 7.3%, semicircular in 4%, water drop-like in 3.2%, round in 2.4% and foot-like in 1.6%. The LAA orifice had a significantly greater (P<0.01) major axis in men (24.79±3.81) than in women (22.68±4.07). The LAA orifice long axis was significantly (P<0.05) positively correlated with the height, weight and surface area of the patient. The LAA morphology parameters displayed strong positive correlation with the left atrium volume, aortic cross area long axis or LSPV long axis but poor correlation with the height, weight, surface area and vertebral body height of the patients. Four types of LAA ridge were identified: AI, AII, B and C with the distribution of 17.6%, 69.9%, 5.9% and 6.6%, respectively. The LAA had a significantly (P<0.05) greater distance from its orifice to the mitral ring in women than in men. The LAA had two filling and two emptying processes with the greatest volume at 45% phase but the least volume at 5% phase. The LAA maximal, minimal and emptying volumes were all significantly (P<0.05) positively correlated with the body height, weight and surface area, whereas the LAA ejection fraction had an inverse correlation with the LAA minimal volume but no correlation with the maximal volume.ConclusionThe LAA has substantially variable morphologies and relation with the adjacent structures, which may be helpful in guiding the LAA trans-catheter occlusion or catheter ablation procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantitative Evaluation of the Substantially Variable Morphology and Function of the Left Atrial Appendage and Its Relation with Adjacent Structures

Gao

Liu

et al. 2015

PLoS ONE

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“…Fibrilace síní je celosvětově nejčastější příčinou CMP. Prevence CMP tedy tvoří socioekonomicky vysoce relevantní složku péče o pacienty s FS [45]. Data týkající se perkutánních metod uzávěru LAA zatím nestačí k tomu, abychom tyto metody doporučovali jakýmkoli pacientům s výjimkou těch, kteří nemohou být dlouhodobě léčeni perorálními antikoagulancii.…”

Section: Diskuseunclassified

Cardiac surgery interventions for stroke prevention in patients with atrial fibrillation

Budera

Straka

2016

Cor Vasa

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Fibrilace síní (FS) je nejčastější příčinou cévní mozkové příhody. Chirurgická ablace FS představuje rychle se rozvíjející oblast kardiochirurgie. Konkomitantní metody a operace pro izolovanou FS jsou pokládány za bezpečný a účinný způsob obnovy sinusového rytmu. Jejich klinický efekt v prevenci cévních mozkových příhod, stejně jako efekt eliminace ouška levé síně zatím stále nebyly jasně prokázány. V tomto článku shrnujeme kardiochirurgické metody aktuálně používané v léčbě FS a při eliminaci ouška levé síně, přičemž zvláštní pozornost je věnována jejich účinnosti z hlediska prevence cévních mozkových příhod.

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“…Nevertheless, financial problems of the manufacturer and a significant rate of adverse events, as mentioned earlier, led to discontinuation of the device in 2006. 37 …”

Section: Percutaneous Laa Closure: Endovascular Approachmentioning

confidence: 99%

Novel nonpharmacologic approaches for stroke prevention in atrial fibrillation: results from clinical trials

Proietti¹,

Joza²,

Arensi³

et al. 2015

MDER

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Atrial fibrillation (AF), the most common cardiac arrhythmia, confers a 5-fold risk of stroke that increases to 17-fold when associated with mitral stenosis. At this time, the most effective long-term solution to protect patients from stroke and thromboembolism is oral anticoagulation, either with vitamin K antagonists (VKAs) or a novel oral anticoagulant (NOAC). Despite the significant benefits they confer, both VKAs and NOACs are underused because of their increased potential for bleeding, and VKAs are underused because of their narrow therapeutic range, need for regular international normalized ratio checks, and interactions with food or medications. In patients with nonvalvular AF, approximately 90% of strokes originate from the left atrial appendage (LAA); in patients with rheumatic mitral valve disease, many patients (60%) have strokes that originate from the left atrium itself. Surgical LAA amputation or closure, although widely used to reduce stroke risk in association with cardiac surgery, is not currently performed as a stand-alone operation for stroke risk reduction because of its invasiveness. Percutaneous LAA closure, as an alternative to anticoagulation, has been increasingly used during the last decade in an effort to reduce stroke risk in nonvalvular AF. Several devices have been introduced during this time, of which one has demonstrated noninferiority compared with warfarin in a randomized controlled trial. This review describes the available technologies for percutaneous LAA closure, as well as a summary of the published trials concerning their safety and efficacy in reducing stroke risk in AF.

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Evidence-Based Percutaneous Closure of the Left Atrial Appendage in Patients with Atrial Fibrillation

Cited by 9 publications

References 65 publications

Quantitative Evaluation of the Substantially Variable Morphology and Function of the Left Atrial Appendage and Its Relation with Adjacent Structures

Quantitative Evaluation of the Substantially Variable Morphology and Function of the Left Atrial Appendage and Its Relation with Adjacent Structures

Cardiac surgery interventions for stroke prevention in patients with atrial fibrillation

Novel nonpharmacologic approaches for stroke prevention in atrial fibrillation: results from clinical trials

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