Percutaneous devices for left atrial appendage occlusion: A contemporary review

Abstract

Patient with atrial fibrillation (AF) are at risk of developing stroke with the left atrial appendage (LAA) being the most common site for thrombus formation. If left untreated, AF is associated with 4 to 5 folds increase in the risk of ischemic stroke in all age groups. About 5% to 15% of AF patients have atrial thrombi on transesophageal echocardiography, and 91% of those thrombi are located in the LAA in patient with nonrheumatic AF. Although oral anticoagulants are the gold-standard treatment for stroke prevention in patients with non-valvular AF, some patients are at high risk of bleeding and deemed not candidates for anticoagulation. Therefore, LAA occlusion (LAAO) has emerged as alternative approach for stroke prevention in those patients. Surgical LAAO is associated with high rate of unsuccessful closure and recommended only in patients with AF and undergoing cardiac surgery. Percutaneous LAAO uses transvenous access with trans-septal puncture and was first tested using the PLAATO device. Watchman is the most common and only Food and Drug Administration (FDA) approved device for LAAO. LAAO using Watchman device is non-inferior to warfarin therapy in preventing ischemic stroke/systemic thromboembolism. However, it is associated with lower rates of hemorrhagic stroke, bleeding and death. Amplatzer is another successful LAAO device that has CE mark and is waiting for FDA approval. Optimal antithrombotic therapy post LAAO is still under debate and highly patient-specific. The aim of this paper is to systematically review the current literature to evaluate the efficacy and safety of different LAAO devices.

Finding Closure: The First WATCHMAN Device in the English-Speaking Caribbean

“…The WATCHMAN (Boston Scientific) is one such device and is the most commonly used worldwide. [2] [3] Here, we report the use of this new technology for the first time in the English-speaking Caribbean.…”

Peri-Device Leaks after Percutaneous Left Atrial Appendage Closure: Clinical Significance and Unmet Diagnostic Needs

“…Comprehensive discussions of the efficacy, technical aspects, and regulatory status of the devices used for LAAO are available in several recent reviews. 17,18 Many, but not all, studies of these devices have systematically defined and reported rates and mechanisms of PDL (Table 1). 17 The incidence of PDL likely depends on the interaction between the LAAO device, anatomical characteristics of the LAA including variability in the morphology of the LAA ostium and body, and possibly tissue characteristics of the underlying atrial tissue (e.g., fibrotic remodeling) ( Figure 1).…”

Clinical Outcomes following Left Atrial Appendage Occlusion: A Single-Center Experience

“…LAA occlusion using the Watchman® device subsequently became a viable alternative to anticoagulation in patients with nonvalvular AF. Although several devices have been introduced for LAA occlusion since 2005 such as Atriclip®, Amplatzer Cardiac Plug®, Amplatzer Amulet® and Lariat® suture delivery device [13, 14], only the Watchman® (Boston Scientific) has received US FDA approval [15]. There are no current guidelines on the choice of short-term antithrombotic therapy following placement of the Watchman® device, the optimal time to discontinue anticoagulation following Watchman® device placement and the duration of follow-up imaging after device deployment.…”