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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Occlusion in Non-Valvular Atrial Fibrillation in a Korean Multi-Center Registry
Jung-Sun Kim1, Hancheol Lee, Yongsung Suh
1Severance Cardiovascular Hospital, Yonsei University College of Medicine.
Insights
Left atrial appendage (LAA) occlusion is a feasible stroke risk reduction strategy for non-valvular atrial fibrillation (AF) patients. Both Amplatzer cardiac plug (ACP) and Watchman devices demonstrated similar clinical outcomes, though ACP showed less leakage.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Non-valvular atrial fibrillation (AF) poses a significant stroke risk.
- Left atrial appendage (LAA) occlusion is an alternative to anticoagulation for stroke prevention.
- Real-world clinical data comparing LAA occlusion devices is crucial.
Purpose of the Study:
- To evaluate the clinical outcomes of LAA occlusion in a real-world setting.
- To compare the efficacy and safety of Amplatzer cardiac plug (ACP) versus Watchman devices for LAA occlusion.
- To assess procedural success rates, complications, and long-term clinical events.
Main Methods:
- A retrospective analysis of 96 patients undergoing LAA occlusion with either ACP (n=50) or Watchman (n=46) devices.
- Patients had non-valvular AF and high risk for stroke and hemorrhage.
- Follow-up included clinical assessment and transesophageal echocardiography.
Main Results:
- High procedural success rate (96.8%) with low serious complication rate (4.1%).
- Mean follow-up of 21.9 months showed low rates of death (5.2%), stroke (4.2%), and major bleeding (1.0%).
- Peridevice leakage was more frequent with Watchman (25.8% overall, with moderate/major leaks) compared to ACP.
Conclusions:
- LAA occlusion is a feasible and effective stroke prevention strategy in high-risk non-valvular AF patients.
- Both ACP and Watchman devices offer comparable procedural and clinical outcomes.
- ACP may be associated with a lower incidence of peridevice leakage compared to Watchman.
Background:
The aim of this study was to evaluate clinical outcome after left atrial appendage (LAA) occlusion in real clinical practice and compare between Amplatzer cardiac plug (ACP) and Watchman.
Methods And Results:
From October 2010 to February 2015, 96 successful LAA occlusion procedures were performed using either ACP (n=50) or Watchman device (n=46) in non-valvular atrial fibrillation (AF) patients (59 male; age, 65.1±9.4 years; CHADS2, 2.5±1.2; CHA2DS2-VASC, 3.9±1.6; HAS-BLED, 2.7±1.3). The procedure success rate was 96.8%. There were serious complications in 4 patients (4.1%; 2 cardiac tamponade, 1 device embolization, and 1 major bleed). The anticoagulation cessation rate after 6 weeks was 92.7%. During mean 21.9-month follow-up, the incidence of death, stroke, systemic embolization and major bleeding was 5.2%, 4.2%, 0% and 1.0%, respectively. On transesophageal echocardiography of 93 patients within 6 months after the procedure, 24 residual leaks were observed (25.8%; 2 mild, 18 moderate, and 4 major). Clinical outcome was similar for the 2 devices, but peridevice leakage was more frequent with the Watchman than the ACP.
Conclusions:
LAA occlusion was feasible in non-valvular AF patients with high risk of stroke and hemorrhage. The ACP and Watchman devices were similar in terms of procedural and clinical outcomes. (Circ J 2016; 80: 1123-1130).
