Left atrial appendage isolation using percutaneous (endocardial/epicardial) devices: Pre-clinical and clinical experience

Romero, Jorge; Engstrom, Krysthel; Biase, Luigi Di

doi:10.1016/j.tcm.2015.05.009

Cited by 9 publications

(8 citation statements)

References 74 publications

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“… 37 Newer devices, currently under investigation, are the Transcatheter Patch (Custom Medical Devices, Athens, Greece), AEGIS (AEGIS, Vancouver, Canada), and the Coherex WaveCrest (Coherex Medical, Salt Lake City, UT, USA). 38 Patients with AF at high stroke risk and with contraindications for OAC should be considered as candidates for LAA closure. Elderly patients often present these characteristics and could benefit from this novel therapy.…”

Section: Management and Treatmentmentioning

confidence: 99%

Managing atrial fibrillation in the very elderly patient: challenges and solutions

Karamichalakis¹,

Letsas²,

Vlachos³

et al. 2015

VHRM

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Atrial fibrillation (AF) is the most common arrhythmia affecting elderly patients. Management and treatment of AF in this rapidly growing population of older patients involve a comprehensive assessment that includes comorbidities, functional, and social status. The cornerstone in therapy of AF is thromboembolic protection. Anticoagulation therapy has evolved, using conventional or newer medications. Percutaneous left atrial appendage closure is a new invasive procedure evolving as an alternative to systematic anticoagulation therapy. Rate or rhythm control leads to relief in symptoms, fewer hospitalizations, and an improvement in quality of life. Invasive methods, such as catheter ablation, are the new frontier of treatment in maintaining an even sinus rhythm in this particular population.

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Section: Management and Treatmentmentioning

confidence: 99%

Managing atrial fibrillation in the very elderly patient: challenges and solutions

Karamichalakis¹,

Letsas²,

Vlachos³

et al. 2015

VHRM

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“…The preliminary results from ASAP revealed that the ischemic stroke rate was less than expected based on historical risk of patients with similar CHADS 2 and CHA 2 DS 2 -Vasc scores (7.4% per year). 30,31 This study also demonstrated a major complication rate of 8.7%, which is lower than the PROTECT AF trial. Long-term safety has been well studied in the case of the WATCHMANt (Boston Scientific) device.…”

Section: The Watchmant Implant Systemmentioning

confidence: 58%

Left Atrial Appendage Closure for Stroke Prevention is Safe and Effective in Selected Patients with Atrial Fibrillation

Iskandar¹,

Afzal²,

Lavu³

et al. 2016

JICRM

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ABSTRACT. The left atrial appendage (LAA) is implicated as a source of thrombus in the majority of patients with atrial fibrillation (AF) and embolic stroke. Therapeutic anticoagulation (AC) is the mainstay of treatment for stroke prophylaxis in AF. Despite adherence to AC, a significant number of patients are still subtherapeutic. In addition to this, several patients are ineligible for AC because of various reasons, including but not limited to high bleeding risk, ongoing bleeding, and non-compliance. These challenges associated with AC led to efforts looking at mechanical isolation of the LAA. Various endocardial and epicardial devices have been tried for mechanical isolation of the LAA, with variable success. The WATCHMANt (Boston Scientific, Maple Grove, MN) is the first endocardial device that received FDA approval as an alternative for warfarin for stroke prophylaxis in AF. The WATCHMANt (Boston Scientific) is not approved for AC-ineligible patients. The LARIAT s (SentreHEART, Inc., Redwood City, CA) is an epicardially deployed device that has been proposed for AC-ineligible patients. Although not FDA approved, its safety and efficacy had been established in large prospective registries. The current review examines the current literature on AC and LAA exclusion devices in a comparative fashion. The protean effects of LARIAT s (SentreHEART, Inc.) on rhythm and neurohormonal control are also reviewed. We conclude that LAA exclusion devices are an excellent alternative to AC for stroke prophylaxis in AC-eligible (WATCHMANt, Boston Scientific) and ineligible patients (LARIAT s , SentreHEART).KEYWORDS. left atrial appendage closure, novel oral anticoagulants, stroke, warfarin.

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“…Until recently, various surgical treatment strategies or percutaneous techniques with different types of devices for LAAC are available. 24,25) Surgical LAAC is divided into two categories: exclusion or excision. 26,27) Epicardial surface exclusion includes running or mattress sutures with or without felt pledgets, purse-string sutures from the epicardial surface, or running sutures or purse-string sutures from the endocardial surface, and single ligation techniques.…”

Section: Current Evidence Derived From Surgical Laa Occlusionmentioning

confidence: 99%

The Efficacy and Safety of the WATCHMAN Device in LAA Occlusion in Patients with Non-Valvular Atrial Fibrillation Contraindicated to Oral Anticoagulation: A Focused Review

Majule

Chang

Rutahoile

et al. 2018

ATCS

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The standard treatment for stroke risk patients with non-valvular atrial fibrillation (NVAF) is the use of oral anticoagulants (OACs). However, a substantial number of patients have relative or absolute contraindications to OACs due to concerns of major bleeding risk and other adverse effects while using oral anticoagulation therapy. Recently, occurrences of exclusion of the left atrial appendage (LAA) in patients with contraindication to anticoagulation therapy are widely expanding worldwide, causing major contentious discussions. The LAA is the commonest place of thrombus formation; therefore, the concept of LAA occlusion in reducing stroke and other embolic events in NVAF patients is very important. The current understanding of the available evidence on efficacy and safety of LAA closure (LAAC) with the Watchman device in patients contraindicated to OACs is the major aim of this focused review. After reviewing a significant body of literature, a world experience with no randomized trials, it is suggested that Watchman device implantation is effective and safe in high-risk patients with NVAF contraindicated to OACs therapy.

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Left atrial appendage isolation using percutaneous (endocardial/epicardial) devices: Pre-clinical and clinical experience

Cited by 9 publications

References 74 publications

Managing atrial fibrillation in the very elderly patient: challenges and solutions

Managing atrial fibrillation in the very elderly patient: challenges and solutions

Left Atrial Appendage Closure for Stroke Prevention is Safe and Effective in Selected Patients with Atrial Fibrillation

The Efficacy and Safety of the WATCHMAN Device in LAA Occlusion in Patients with Non-Valvular Atrial Fibrillation Contraindicated to Oral Anticoagulation: A Focused Review

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