Percutaneous left atrial appendage closure

Czech version

Authors: Marek Hozman ¹; Pavel Osmančík ²
Authors‘ workplace: Kardiocentrum Karlovarské krajské nemocnice, a. s., Karlovy Vary ¹; III. interní – kardiologická klinika 3. LF UK a FN Královské Vinohrady, Praha ²
Published in: Vnitř Lék 2020; 66(6): 1-9
Category:

Overview

Stroke is one of the most severe complications of atrial fibrillation. Oral anticoagulation is the first choice therapy in prevention of cardiac embolic events. Particularly in patients with the history of serious bleeding, oral anticoagulation may be contraindicated. Percutaneous left atrial appendage closure represents an alternative in prophylaxis of cardiac embolic events. This review article describes physiology and pathophysiology of the left auricle, the most frequently used devices and their indications and scientific rationale.

Keywords:

atrial fibrillation – left auricle – occlusion – stroke

Sources

1. Lloyd-Jones DM, Wang TJ, Leip EP, et al. Lifetime Risk for Development of Atrial Fibrillation. Circulation 2004; 110: 1042–1046.

2. Staerk L, Wang B, Preis SR, et al. Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham Heart Study. BMJ 2018; k1453. https://doi.org/10.1136/bmj.k1453

3. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991; 22: 983–988.

4. Libby P, Braunwald E. Braunwald’s heart disease: A textbook of cardiovascular medicine (8th ed.). Philadelphia, Pa 2008, Edinburgh: Saunders Elsevier

5. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. The Annals of Thoracic Surgery 1996; 61: 755–759.

6. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial Fibrillation. Annals of Internal Medicine 2007; 146: 857.

7. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal 2016; 37: 2893–2962.

8. Rubboli A. Incidence, clinical impact and risk of bleeding during oral anticoagulation therapy. World Journal of Cardiology 2011; 3: 351.

9. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. New England Journal of Medicine 2011; 365: 883–891.

10. Hicks T, Stewart F, Eisinga A. NOACs versus warfarin for stroke prevention in patients with AF: a systematic review and meta-analysis. Open Heart 2016; 3: e000279.

11. Kimmel SE. The Influence of Patient Adherence on Anticoagulation Control With Warfarin. Archives of Internal Medicine 2007; 167: 229.

12. Pfeilschifter LS, Hohmann C, Niemann D, et al. Adherence to oral anticoagulant therapy in secondary stroke prevention dash; impact of the novel oral anticoagulants. Patient Preference and Adherence 2015; 1695. https://doi.org/10.2147/ppa.s88994

13. Katz ES, Tsiamtsiouris T, Applebaum RM, et al. Surgical left atrial appendage ligation is frequently incomplete: a transesophageal echocardiographic study. Journal of the American College of Cardiology 2000; 36: 468–471.

14. Friedman DJ, Piccini JP, Wang T, et al. Association Between Left Atrial Appendage Occlusion and Readmission for Thromboembolism Among Patients With Atrial Fibrillation Undergoing Concomitant Cardiac Surgery. JAMA 2018; 319: 365.

15. Regazzoli D, Ancona F, Trevisi N, et al. Left Atrial Appendage: Physiology, Pathology, and Role as a Therapeutic Target. BioMed Research International 2015; 2015: 1–13.

16. Sadler TW, Langman J. Langman’s medical embryology (12th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2012.

17. Ho SY, Cabrera JA, Sanchez-Quintana D. Left Atrial Anatomy Revisited. Circulation: Arrhythmia and Electrophysiology 2012; 5: 220–228.

18. Beigel R, Wunderlich NC, Ho SY, et al. The Left Atrial Appendage: Anatomy, Function, and Noninvasive Evaluation. JACC: Cardiovascular Imaging 2014; 7: 1251–1265.

19. Di Biase L, Santangeli P, Anselmino M, et al. Does the Left Atrial Appendage Morphology Correlate With the Risk of Stroke in Patients With Atrial Fibrillation? Journal of the American College of Cardiology 2012; 60: 531–538.

20. Hoit BD, Shao Y, Tsai LM, et al. Altered left atrial compliance after atrial appendectomy. Influence on left atrial and ventricular filling. Circ Res 1993; 72: 167–175.

21. Bansal M, Kasliwal RR. Echocardiography for left atrial appendage structure and function. Indian Heart Journal 2012; 64: 469–475.

22. García-fernández MA, Torrecilla EG, San román D et al. Left atrial appendage Doppler flow patterns: implications on thrombus formation. Am Heart J 1992; 124: 955–961.

23. Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography. Ann Intern Med 1998; 128: 639–647.

24. Chapeau C, Gutkowska J, Schiller PW, et al. Localization of immunoreactive synthetic atrial natriuretic factor (ANF) in the heart of various animal species. J Histochem Cytochem 1985; 33: 541–550.

25. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14: e275–e444.

26. Friedman DJ, Black-Maier EW, Barnett AS, et al. Left Atrial Appendage Electrical Isolation for Treatment of Recurrent Atrial Fibrillation. JACC: Clinical Electrophysiology 2018; 4: 112–120.

27. Rillig A, Tilz RR, Lin T, et al. Unexpectedly High Incidence of Stroke and Left Atrial Appendage Thrombus Formation After Electrical Isolation of the Left Atrial Appendage for the Treatment of Atrial Tachyarrhythmias. Circulation: Arrhythmia and Electrophysiology 2016; 9: https://doi.org/10.1161/circep.115.003461

28. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation 2019; https://doi.org/10.1161/cir.0000000000000665

29. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke 2014; 45: 2160–2236.

30. Alkhouli M, Rihal CS, Holmes jr. DR. Transseptal Techniques for Emerging Structural Heart Interventions. JACC: Cardiovascular Interventions 2016; 9: 2465–2480.

31. Perrotta L, Bordignon S, Dugo D, et al. Complications From Left Atrial Appendage Exclusion Devices. Journal of atrial fibrillation 2014; 7: 1034.

32. Holmes DR, Reddy VY, Turi ZG, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. The Lancet 2009; 374: 534–542.

33. Holmes jr. DR, Kar S, Price MJ, et al. Prospective Randomized Evaluation of the Watchman Left Atrial Appendage Closure Device in Patients With Atrial Fibrillation Versus Long-Term Warfarin Therapy. Journal of the American College of Cardiology 2014; 64: 1–12.

34. Reddy VY, Möbius-Winkler S, Miller MA, et al. Left Atrial Appendage Closure With the Watchman Device in Patients With a Contraindication for Oral Anticoagulation. Journal of the American College of Cardiology 2013; 61: 2551–2556.

35. Reddy VY, Doshi SK, Kar S, et al. 5-Year Outcomes After Left Atrial Appendage Closure. Journal of the American College of Cardiology 2017; 70: 2964–2975.

36. Boersma LVA, Schmidt B, Betts TR, et al. Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry. European Heart Journal 2016; 37: 2465–2474.

37. Tzikas A, Shakir S, Gafoor S, et al. Left atrial appendage occlusion for stroke prevention in atrial fibrillation: multicentre experience with the AMPLATZER Cardiac Plug. EuroIntervention 2016; 11: 1170–1179.

38. Tzikas A. Left Atrial Appendage Occlusion with Amplatzer Cardiac Plug and Amplatzer Amulet: a Clinical Trials Update. Journal of Atrial Fibrillation 2017; 10: https://doi. org/10.4022/jafib.1651

39. Korsholm K, Nielsen K, Jensen J, et al. Transcatheter left atrial appendage occlusion in patients with atrial fibrillation and a high bleeding risk using aspirin alone for post-implant antithrombotic therapy. EuroIntervention 2017; 12: 2075–2082.

40. Weise FK, Bordignon S, Perrotta L, et al. Short-term dual antiplatelet therapy after interventional left atrial appendage closure with different devices. EuroIntervention 2018; 13: 2138–2146.

41. Srivastava MC, See VY, Dawood MY, et al. A review of the LARIAT device: insights from the cumulative clinical experience. SpringerPlus 2015; 4: https://doi.org/10.1186/s40064015-1289-8

42. Han FT, Bartus K, Lakkireddy D, et al. The effects of LAA ligation on LAA electrical activity. Heart Rhythm 2014; 11: 864–870.

43. Afzal MR, Kanmanthareddy A, Earnest M, et al. Impact of left atrial appendage exclusion using an epicardial ligation system (LARIAT) on atrial fibrillation burden in patients with cardiac implantable electronic devices. Heart Rhythm 2015; 12: 52–59.