Outcomes of left atrial appendage occlusion using the AtriClip device: a systematic review

Abstract

Atrial fibrillation increases lifetime stroke risk. The left atrial appendage (LAA) is thought to be the source of embolic strokes in up to 90% of cases, and occlusion of the LAA may be safer than the alternative of oral anticoagulation. Occlusion devices, such as the AtriClipTM (AtriCure, Mason, OH, USA) enable safe and reproducible epicardial clipping of the LAA. A systematic review was performed in May 2018, based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, using the keyword ‘AtriClip’. A total of 68 papers were identified and reviewed; 11 studies were included. Data including demographics, medical history intervention(s) performed, periprocedural outcomes and follow-up were assessed and analysed. A total of 922 patients were identified. LAA occlusion was achieved in 902 out of 922 patients (97.8%). No device-related adverse events were reported across the studies. The reported incidence of stroke or transient ischaemic attack post-clip placement ranged from 0.2 to 1.5/100 patient-years. Four hundred and seventy-seven of 798 patients (59.7%) had ceased anticoagulation on follow-up. The AtriClip device is safe and effective in the management of patients with atrial fibrillation, either as an adjunct in patients undergoing cardiac surgery or as a stand-alone thoracoscopic procedure.

Left atrial appendage occlusion device causing coronary obstruction: A word of caution

“…Left atrial appendage occlusion (LAAO) is recommended for patients with atrial fibrillation undergoing elective cardiac surgery 1 . Studies are reporting excellent outcomes for the AtriClip LAAO device without major device‐related complications in several clinical trials 2 . Here, we report the first case of delayed severe coronary artery stenosis with NSTEMI after implantation of the AtriClip device during open‐heart surgery with sternotomy.…”

Revisiting Antiarrhythmic Drug Therapy for Atrial Fibrillation: Reviewing Lessons Learned and Redefining Therapeutic Paradigms

“…Various refinements beyond pulmonary vein isolation, including complex fractionated atrial electrograms (CFAEs), focal impulse and rotor modulation (FIRM), electrocardiographic imaging (ECGI), have been explored but met with variable, inconsistent success (Weiss et al, 2016). For left atrial appendage occlusion, the AtriClip device has gained increasing popularity over the last decade as a safe and efficacious alternative to surgical closure and can be easily deployed during concomitant open chest surgery or standalone minimally invasive procedure (Ellis et al, 2017;Caliskan et al, 2018;Toale et al, 2019).…”

“…Quinidine, one of the oldest antiarrhythmic drugs, was used extensively in the 20th century for a variety of arrhythmias, including AF ( Askey, 1946 ; McMillan and Welfare, 1947 ; Wegria, 1947 ). The combination of quinidine and verapamil has similar efficacy in preventing AF recurrences as sotalol but with better safety profile ( Fetsch et al, 2004 ; Patten et al, 2004 ).…”

Electrical Isolation of the Left Atrial Appendage - A New Frontier in the Treatment for Atrial Fibrillation

“…A longer-term dataset published in 2014 by Emmert et al showed good long-term stability of the device, without any dislodgement, out to 36 months [52]. Subsequently, many studies have been conducted to show the high levels of success and safety in deploying the AtriClip device, including a recent systematic review of 11 studies by Toale et al [53]. At present, there is a current lack of adequately powered, prospective, randomised studies to accurately assess the reduction in risk of stroke with the use of the AtriClip; however, there is very encouraging evidence from smaller-scale or non-randomised studies, a large registry study, and a systematic review [42,[53][54][55][56].…”