Systematic review on left atrial appendage closure with the LAmbre device in patients with non-valvular atrial fibrillation

Abstract

Background: Percutaneous closure (LAAC) of the left atrial appendage (LAA) is an efficacious preventive procedure for patients with non-valvular atrial fibrillation (NVAF) and considerable bleeding risk. We sought to systematically review the available LAAC data on the novel occluder device LAmbre™. Methods: For this systematic review, a search of the literature was conducted by 3 independent reviewers, reporting the safety and therapeutic success of LAAC in patients being treated with a LAmbre™. Publications reporting the safety and therapeutic success of LAAC using LAmbre™ in n > 5 patients were included. Results: The literature search retrieved n = 10 publications, encompassing n = 403 NVAF patients treated with a LAmbre™ LAAC, with relevant data regarding safety and therapeutic success of the procedure. The mean CHA 2 DS 2-VASc Score was 4.0 + 0.9, and the mean HAS-BLED score was 3.4 + 0.5. The implantation success was 99.7%, with a mean procedure time of 45.4 ± 18.7 min, and a fluoroscopy time of 9.6 ± 5.9 min, and a contrast agent volume of 96.7 ± 0.7 ml. The anticoagulation regimen was switched to DAPT post procedure in the majority of the patients (96.8%). Partial and full recapture were done in 45.5% and in 25.6%, respectively. Major complications were reported in 2.9%, with 0.3% mortality, 1.7% pericardial tamponade, 0.3% stroke, and 0.6% major bleeding complications; no device embolization was observed. During follow up at 6 or 12 months, major adverse cardiovascular events were reported in 3.3%: Stroke or TIA in 1.7%, thrombus formation on the device in 0.7%, and residual flow > 5 mm in 1.0%. In some publications, the favorable implantion properties of the LAmbre™ for difficult anatomies such as shallow or multilobular LAA anatomies were described. Conclusions: This systematic review on the LAmbre™ LAA-occluder including n = 403 NVAF patients demonstrates an excellent implantion success rate, promising follow-up clinical data, and favorable properties for also challenging LAA anatomies,. While its design seems to be helpful in preventing device embolization, pericardial tamponade may not be substantially reduced by the LAmbre™ as compared with other established LAAC devices. Further larger prospective multicenter registries and randomized trials are needed to scrutinize the value of the LAmbre™ compared with established LAAC devices.

Feasibility and safety of left atrial appendage occlusion guided by procedural fluoroscopy only: A pilot study

“…The implantation success rate was generally over 96.0% with procedural guidance of TEE or ICE or fluoroscopy only for Watchman, WATCHMAN FLX, Amplatzer, and LAmbre device 7,9,16,17,26–29 . The device success was comparable for both occluders in the present study.…”

Percutaneous left atrial appendage occlusion in the current practice

“…Briefly, the LAmbre device is distinguished by achieving very high procedural success rates at 99-100%, with a low incidence of peri-procedural complications (2.9%), despite being frequently employed in patients with challenging LAA anatomies, as are shallow or multilobe LAA or those with a very wide ostium [17].…”

A predictive study of multivariate factors affecting goal attainment of INR after anticoagulation in patients with nonvalvular atrial fibrillation

“…Barrios et al (12) pointed out that although warfarin shows a good therapeutic effect, it takes a long time to reach the ideal INR, and the maintenance time of the target range of INR is short. Ali et al's study on the recommended anti-thrombotic strategies after valve replacement suggested that patients with mechanical or biological valve replacement should use warfarin for anticoagulation after surgery, and the INR value should be maintained at 2.0-3.0 to reach anticoagulation standards (13). Therefore, in order to ensure the INR compliance rate of anticoagulation therapy, it is of great significance to analyze the factors that affect INR goal attainment.…”