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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Percutaneous Left Atrial Appendage Exclusion Therapy: Who, Why and How?
Sven Möbius-Winkler1, Ingo Dähnert2, Gerhard C Schuler1
1Universität Leipzig, Herzzentrum GmbH, Department of Internal Medicine/Cardiology, Leipzig, Germany.
Insights
Left atrial appendage (LAA) exclusion offers an alternative stroke prevention strategy for atrial fibrillation (AF) patients ineligible for anticoagulation. Devices like the WATCHMAN show promise, with ongoing trials comparing them to standard therapies.
Area of Science:
- Cardiology
- Medical Devices
- Stroke Prevention
Background:
- Patients with atrial fibrillation (AF) face a heightened risk of cardioembolic stroke.
- Standard antithrombotic therapy is not suitable for all AF patients.
- Left atrial appendage (LAA) exclusion presents an alternative stroke prevention method.
Purpose of the Study:
- To review strategies for LAA exclusion.
- To focus on the WATCHMAN device for LAA occlusion.
- To assess the safety and feasibility of LAA exclusion devices.
Main Methods:
- Review of existing literature on LAA exclusion devices.
- Analysis of data from patients treated with PLAATO, AMPLATZER, and WATCHMAN devices.
- Focus on percutaneous transcatheter occlusion techniques.
Main Results:
- Both WATCHMAN and AMPLATZER devices demonstrated safety and feasibility for LAA occlusion.
- PLAATO device, though discontinued, showed efficacy in high-risk patients.
- Reduction in stroke risk was observed in patients treated with these devices.
Conclusions:
- LAA exclusion is a viable option for stroke prevention in select AF patients.
- Ongoing trials are crucial to establish noninferiority to oral anticoagulation.
- Successful LAA occlusion could provide a new therapeutic avenue for ischemic stroke prevention.
Abstract:
Purpose: Patients with atrial fibrillation are at an increased risk of having a cardio embolic stroke. Stroke is a leading cause of death and disability worldwide. Current guidelines recommend an antithrombotic regimen to prevent thromboembolism in medium and high risk patients with AF. However, a substantial number of patients are not eligible for this therapy. The exclusion of the left atrial appendage (LAA) from circulation seems to be an alternative strategy for stroke prevention in AF. This review focuses on the different strategies for LAA exclusion with special focus on the WATCHMAN Device. Two devices are currently in use for percutaneous transcatheter occlusion of the LAA: the WATCHMAN® - device and the AMPLATZER® -septal occluder. For both devices safety and feasibility data are available. Additionally about 200 patients received a PLAATO® -device- which is currently no more available due to economic reasons. Patients treated with the PLAATO device were at high risk for thromboembolic stroke and had contraindications for oral anticoagulation therapy. The Watchman® -device was implanted in 800 patients that were eligible for long-term anticoagulation therapy with a moderate risk for thromboembolic stroke due to non-valvular AF. Summary: For both devices, a reduction in the risk of stroke was documented and device implantation was shown to be safe and feasible. Provided the ongoing trials show noninferiority to oral anticoagulation, another therapeutic option will become available to prevent ischemic strokes.
