Left Atrial Appendage Closure Devices

Abstract

Atrial fibrillation (AF) increases the risk for thromboembolic stroke five-fold. The left atrial appendage (LAA) has been shown to be the main source of thrombus formation in the majority of strokes associated with AF. Oral anticoagulation with warfarin and novel anticoagulants remains the standard of care; however, it has several limitations, including bleeding and poor compliance. Occlusion of the LAA has been shown to be an alternative therapeutic approach to drug therapy. The purpose of this article is to review the different techniques and devices that have emerged for the purpose of occluding this structure, with a particular emphasis on the efficacy and safety studies published to date in the medical literature.

Mechanical properties of currently available left atrial appendage occlusion devices: A bench‐testing analysis

“…The results presented in our analysis indicate that it might be possible to define the minimal TF range necessary for LAAO devices. Considering the clinical success and low adverse event rates of the Amulet and the WATCHMAN implants, the most widely studied devices worldwide, the observed TF range of 1.5‐3.3 N might be considered appropriate; however, defining a clear lower threshold remains difficult. The LAmbre, the Cardia, and the ACP devices were well within that range, whereas the WaveCrest device showed higher TF values of up to 4.6 N. The Occlutech device showed lower TFs and has been recalled due to anchoring issues that have led to device embolization.…”

Complete Obliteration of the Left Atrial Appendage an Analysis of Epicardial Excision and Novel Pericardial Patch Exclusion

“…21 Although these devices show promise in effectively occluding the LAA, there are still potential risks with their use including device embolization, pericarditis, pericardial effusion, cardiac tamponade, and LAA tearing. 22,23 Most importantly, stroke reduction rates with these percutaneous devices have been disappointingly modest, 22 perhaps related to the inherent thrombogenic nature of an intravascular foreign body and need for dual antiplatelet therapy. The PPE technique follows the principle of covering the entire LAA orifice tension free, with an autologous pericardial patch, which has been proven with extremely low thromboembolic risks and to maintain stable atrial wall closure in atrial septal defect repair.…”

Giant left atrial appendage aneurysm and atrial fibrillation: chicken or the egg?

“…Dabigatran 150 mg twice daily was started orally to prevent stroke considering the SEC inside the LA and the small thrombus inside the LAAA. Consultation was taken with the heart team, and LAAA closure devices were deemed inappropriate considering the large left atrial appendage (LAA) ostium 3. Thus, surgical ligation of the LAAA with removal of the clot was advised, but the patient chose to stay on anticoagulants.…”