Percutaneous Left Atrial Appendage Transcatheter Occlusion to Prevent Stroke in High-Risk Patients With Atrial Fibrillation

Sievert, Horst; Lesh, Michael D.; Trian, Thomas; Omran, Heyder; Bartorelli, Antonio L.; Bella, P. Della; Nakai, Toshiko; Reisman, Mark; DiMario, Carlo; Block, Peter C.; Kramer, Paul H.; Fleschenberg, Dirk; Krumsdorf, Ulrike; Scherer, D

doi:10.1161/01.cir.0000015698.54752.6d

Cited by 411 publications

(232 citation statements)

References 22 publications

(16 reference statements)

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“…However, a longer-time registry demonstrated that the use of septal occluders for LAA occlusion was associated with lower success and higher embolization rates when compared to the implantation of dedicated devices. * The first dedicated device for LAA occlusion was the PLAATO System (ev3, Plymouth, MN, no longer available), first implanted in 2001 25 . It consisted of a self-expandable nitinol cage covered with a non-thrombogenic PTFE membrane.…”

Section: Discussionmentioning

confidence: 99%

Oclusão do apêndice atrial esquerdo com o Amplatzer Cardiac Plug em pacientes com fibrilação atrial

Guérios¹,

Schmid²,

Gloekler³

et al. 2012

Arq. Bras. Cardiol.

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Results: All implants were guided by angiography alone. Procedural success was 99% (one patient suffered a cardiac tamponade requiring pericardiocentesis, and the procedure was waived). There were four major complications (the already mentioned cardiac tamponade, two transient ischemic attacks and one device embolization with percutaneous retrieval) and two minor complications (one pericardial effusion without clinical significance and one non-significant ASD evidenced at FU). There was one in-hospital death after six days, unrelated to the procedure. All other patients were discharged without OA. After 25.9 patient-years of FU (69 patients), there were no strokes and no late device embolization. The LAA was completely closed in 97% of the cases. Six patients showed evidence of thrombus formation on the device, which resolved after three months of OA. Conclusion

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Section: Discussionmentioning

confidence: 99%

Oclusão do apêndice atrial esquerdo com o Amplatzer Cardiac Plug em pacientes com fibrilação atrial

Guérios¹,

Schmid²,

Gloekler³

et al. 2012

Arq. Bras. Cardiol.

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“…45,46 It is widely believed that formation and embolism of left atrial appendage thrombi are responsible for the increased risk of stroke in AF patients. 4,47,48 Each year, Ϸ60 000 Americans with AF experience strokes; these strokes are often large and devastating, emphasizing the need for primary prevention.…”

Section: Future Directions: the Left Atrial Appendagementioning

confidence: 99%

Advances in Surgical Treatment of Atrial Fibrillation

Gillinov

2007

Stroke

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Abstract-Atrial fibrillation (AF) is the most common sustained arrhythmia. It is associated with increased risks of death and stroke; most strokes in AF patients are thought to arise from thrombi in the left atrial appendage. Surgical ablation of AF includes excision of the left atrial appendage and is an effective means of treating this arrhythmia, with the classic Maze procedure curing AF in Ͼ90% of patients and virtually eliminating the risk of late stroke. A complex but safe operation, the Maze procedure has been applied by relatively few surgeons. Americans; this number is expected to increase to Ͼ5.6 million by 2050. 1 The prevalence of AF increases with increasing patient age, and recent data from the Framingham Heart Study suggest that the lifetime risks for development of AF are 1 in 4 for men and women aged Ն40 years. 2 This epidemic has a growing impact on the healthcare system and a multibillion dollar cost. The clinical consequences of AF are well documented. AF is associated with reduced life expectancy and increases the risk of stroke 5-fold, accounting for Ϸ15% of all strokes nationally. 3-8 These AF-related strokes are a major challenge and a focus of several clinical trials investigating strategies for primary and secondary prevention. 4 Currently, antithrombotic therapy is the mainstay for stroke prevention in AF patients.Although there is currently some consensus concerning pharmacological strategies for stroke prevention in AF patients, choice of therapy for the heart rhythm is controversial and evolving. 9,10 Available antiarrhythmic therapies inconsistently restore sinus rhythm and are associated with complications. In fact, the risks associated with antiarrhythmic drug therapy may counterbalance the potential benefit of restoration of sinus rhythm. 9,10 These observations, coupled with increased understanding of the pathogenesis of AF, have resulted in the development of interventional strategies to restore sinus rhythm. Both catheter-based and surgical approaches have demonstrated effectiveness in this regard. Developed by Dr James Cox, the classic Maze procedure is the predicate operation for ablation of AF; long-term data suggest that the Maze procedure eliminates AF in Ͼ90% of patients. 11-14 Despite these unmatched results, the complexity and time associated with the Maze procedure have prevented widespread application by surgeons.Recently, however, there has been increased interest in direct surgical ablation of AF, fueled by technological advances and demonstration that the pulmonary veins and left atrium are the drivers of AF in most patients. 15 New ablation technologies enable surgeons to perform pulmonary vein isolation, create strategically placed, linear left atrial lesions, and excise the left atrial appendage rapidly and safely. 16 -23 Alternate energy sources used to create lines of conduction block and replace surgical incisions of the Maze procedure include radiofrequency, microwave, ultrasound, cryothermy, and laser. 16 -25 Applied primarily in patients with valvular...

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“…P ercutaneous occlusion of the left atrial appendage (LAA) has been used as an alternative to oral anticoagulation in patients for whom this strategy is not safe. [1][2][3][4][5][6] It is a routinely performed procedure, including in Brazil. [7][8][9] Patent foramen ovale (PFO) is located more cranially in the septum, and it is believed that its use as an access route for LAA occlusion hinders the correct positioning of the delivery sheath.…”

Section: Descritoresmentioning

confidence: 99%

Oclusão Percutânea do Apêndice Atrial Esquerdo e do Forame Oval Patente no Mesmo Procedimento sem Necessidade de Punção Transeptal

Chamié

Simöes

et al. 2014

Rev. Bras. Cardiol. Invasiva

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Left atrial appendage occlusion has been successfully employed to prevent embolic events in patients with atrial fibrillation as an alternative to oral anticoagulation. Left atrial access through the patent foramen ovale or ostium secundum atrial septal defect has been discouraged due to the fear that entering the septum in a higher position through the foramen would prevent adequate device positioning. In this manuscript we report a case in which the left atrial appendage and the foramen ovale were sequentially occluded avoiding transseptal puncture, making the procedure simpler and faster. DESCRIPTORS:

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Percutaneous Left Atrial Appendage Transcatheter Occlusion to Prevent Stroke in High-Risk Patients With Atrial Fibrillation

Cited by 411 publications

References 22 publications

Oclusão do apêndice atrial esquerdo com o Amplatzer Cardiac Plug em pacientes com fibrilação atrial

Oclusão do apêndice atrial esquerdo com o Amplatzer Cardiac Plug em pacientes com fibrilação atrial

Advances in Surgical Treatment of Atrial Fibrillation

Oclusão Percutânea do Apêndice Atrial Esquerdo e do Forame Oval Patente no Mesmo Procedimento sem Necessidade de Punção Transeptal

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