Percutaneous left atrial appendage closure – new method of stroke prevention in patients with atrial fibrillation Review article
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Published:
Jun 30, 2012
Keywords:
atrial fibrillation, left atrial appendage (LAA), stroke, percutaneous LAA occlusion devices
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Abstract
Atrial fibrillation is the common cardiac arrhythmia. One of the primary objectives in managing atrial fibrillation is to reduce the rate of embolic phenomenon. Long term anticoagulation with warfarin or new anticoagulants remains the mainstay of stroke prevention. Nearly 20% of patients with atrial fibrillation in whom anticoagulation is recommended have contraindication to such therapy. In patients with non-valvular atrial fibrillation more than 90% of atrial thrombi arise in the left atrial appendage. Percutaneous left atrial appendage occlusion devices appear to be promising alternative for patients in whom long term anticoagulation is contraindicated.
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Janiszewski , M., & Chmielewski , M. (2012). Percutaneous left atrial appendage closure – new method of stroke prevention in patients with atrial fibrillation. Medycyna Faktow (J EBM), 5(2(15), 74-78. Retrieved from https://journalsmededu.pl/index.php/jebm/article/view/2470
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References
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14. Block P.C., Burstein S., Casale P.N. et al.: Percutaneous left atrial appendage occlusion for patients in atrial fibrillation suboptimal for warfarin therapy – 5-year results of the PLATOO Study. JACC Cardiovasc. Interv. 2009; 2: 594-600.
15. Holmes D.R., Reddy V.Y., Turi Z.G. et al.: Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomized non-inferiority trial. Lancet 2009; 374: 534-542.
16. Reddy V.Y., Holmes D.R., Doshi S.K. et al.: Safety of percutaneous left atrial appendage closure: results from Watchman Left Atrial Appendage System for Embolic Protection In Patients With AF (Protect AF) clinical trial and the Continued Access Registry. Circulation 2011; 123: 417-24.
17. Park J.W., Bethencourt A., Sievert H. et al.: Left atrial appendage closure with Amplazer cardiac plug in atrial fibrillation: initial European experience. Catheter. Cardiovasc. Interv. 2011; 77: 700-706.
2. Stroke Prevention In Atrial Fibrillation Study. Final Results. Circulation 1991; 84: 527-39.
3. Connolly S.J., Laupacis A., Gesnt M. et al.: Canadian Atrial Fibrillation Anticoagulation (CAFA) Study. JACC 1991; 18: 349-55.
4. Cooper N.J., Sutton A.J., Lu G. et al.: Mixed comparison of stroke prevention treatments in individuals with nonrheumatic atrial fibrillation. Arch. Intern. Med. 2006; 166: 1269-75.
5. Van Walraven C., Jennings A., Oake N. et al.: Effect of study settings on anticoagulation control: a systemic review and metaregression. Chest 2006; 129: 1155-66.
6. Connolly S.J., Ezekowitz M.D., Yusuf S. et al.: Dabigatran versus warfarin in patients with atrial fibrillation. NEJM 2009; 361: 1139-51.
7. Patel M.R., Mahaffey K.W., Garg J. et al.: Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. NEJM 2011; 365: 883-891.
8. Granger C.B., Alexander J.H., McMurray J.J. et al.: Apixaban versus warfarin in patients with atrial fibrillation. NEJM 2011; 365: 981-992.
9. Gottlieb L.K., Salem-Schatz S.: Anticoagulation in atrial fibrillation. Does efficacy in clinical trials translate into effectiveness in practice. Arch. Intern. Med. 1994; 154: 1945-53.
10. The Stroke Prevention In Atrial Fibrillation Investigator Committee on Echocardiography. Transesophageal echocardiography correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation. Ann. Intern. Med. 1998; 128: 639-647.
11. 2008 Focused update incorporated into the ACC/AHA guidelines for the management of patients with valvular heart disease: a report of the ACC/AHA Task Force on Practice Guidelines. Circulation 2008; 118: 523-661.
12. Cox J.L.: The surgical treatment of atrial fibrillation. J. Thorac. Cardiovasc. Surg. 1991; 101: 584-592.
13. Ostermayer S.H., Reisman M., Kramer P.H. et al.: Percutaneous left atrial appendage transcatheter occlusion (PLATOO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation. Results from the international multicenter feasibility trials. JACC 2005; 111: 9-14.
14. Block P.C., Burstein S., Casale P.N. et al.: Percutaneous left atrial appendage occlusion for patients in atrial fibrillation suboptimal for warfarin therapy – 5-year results of the PLATOO Study. JACC Cardiovasc. Interv. 2009; 2: 594-600.
15. Holmes D.R., Reddy V.Y., Turi Z.G. et al.: Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomized non-inferiority trial. Lancet 2009; 374: 534-542.
16. Reddy V.Y., Holmes D.R., Doshi S.K. et al.: Safety of percutaneous left atrial appendage closure: results from Watchman Left Atrial Appendage System for Embolic Protection In Patients With AF (Protect AF) clinical trial and the Continued Access Registry. Circulation 2011; 123: 417-24.
17. Park J.W., Bethencourt A., Sievert H. et al.: Left atrial appendage closure with Amplazer cardiac plug in atrial fibrillation: initial European experience. Catheter. Cardiovasc. Interv. 2011; 77: 700-706.