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Published on: February 26, 2013
Percutaneous atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: a systematic
Stine Munkholm-Larsen1, Christopher Cao, Tristan D Yan
1The University of Copenhagen, Copenhagen, Denmark.
Insights
Percutaneous left atrial appendage occlusion (PLAAO) shows promise for stroke prevention in atrial fibrillation (AF) patients, with high success rates and low periprocedural risks. Further large trials are needed to confirm its long-term efficacy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Stroke Prevention
Background:
- Atrial fibrillation (AF) poses a significant stroke risk.
- Anticoagulation therapy is standard but carries bleeding risks.
- Left atrial appendage occlusion (LAAO) offers an alternative stroke prevention strategy.
Purpose of the Study:
- To systematically review the safety and efficacy of percutaneous left atrial appendage occlusion (PLAAO).
- To evaluate PLAAO as a stroke prevention method for patients with AF.
- To assess procedural success and complication rates of PLAAO.
Main Methods:
- Systematic review of peer-reviewed literature.
- Searched three electronic databases for studies on PLAAO published before June 2011.
- Included 14 identified studies for analysis.
Main Results:
- Successful implantation achieved in 93% of cases.
- Periprocedural mortality and stroke rates were 1.1% and 0.6%, respectively.
- Incidence of pericardial effusion/tamponade was 4%, and device embolisation was 0.7%.
- Annual stroke incidence at follow-up (up to 40 months) was 1.4%.
Conclusions:
- PLAAO appears to be a relatively safe treatment option for stroke prevention in AF patients.
- Evidence suggests PLAAO is effective in reducing stroke risk.
- Further large-scale, well-designed randomized controlled trials are necessary to definitively establish PLAAO efficacy.
Abstract:
This review aims to evaluate systematically the safety and efficacy of percutaneous left atrial appendage occlusion (PLAAO) in stroke prevention for patients with atrial fibrillation (AF). A systematic review of peer-reviewed journals on PLAAO before June 2011 was performed on three electronic databases. Fourteen studies were identified for evaluation. Overall, implantation was successful in 93% of all cases. Periprocedural mortality and stroke rates were 1.1% and 0.6%, respectively. The incidences of pericardial effusion/cardiac tamponade and device embolisation were 4% and 0.7%, respectively. At the time of the latest follow-up (up to 40 months), the overall incidence of stroke among all studies was 1.4% per annum. Existing evidence suggests that PLAAO is a relatively safe treatment for patients with AF. However, there is a need for further evaluation of its efficacy in the form of large and well-designed randomised controlled trials.
