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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Left atrial appendage occlusion: Percutaneous and surgical approaches in everyday practice
Jan Gofus1, Pavel Zacek2, Youssef Shahin2
1Department of Cardiac Surgery, Charles University, Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic. jan.gofus@gmail.com.
Insights
Prophylactic left atrial appendage occlusion effectively reduces cardioembolism risk in atrial fibrillation patients. Concerns regarding adverse effects are not supported by current evidence, though hemodynamic impacts require further study.
Area of Science:
- Cardiology
- Medical Devices
- Thrombosis Management
Background:
- Atrial fibrillation (AF) poses a significant risk of cardioembolic events.
- Left atrial appendage occlusion (LAAO) is explored to mitigate this risk.
- Conflicting data exist regarding LAAO's clinical benefits and potential adverse effects.
Purpose of the Study:
- To comprehensively review the literature on prophylactic LAAO in AF patients.
- To evaluate the efficacy and safety of LAAO for reducing thromboembolism.
- To provide clinical recommendations for LAAO decision-making.
Main Methods:
- A systematic literature search was performed using Medline via PubMed.
- Sixty-five relevant articles were selected based on title and abstract review.
- The review focused on thromboembolism risk reduction, safety, and adverse effects.
Main Results:
- Concomitant LAAO during cardiac surgery is effective for thromboembolism risk reduction in AF patients with high CHA2DS2-VASc scores.
- Surgical epicardial closure is a safe and preferred technique; thoracoscopic and transcatheter methods are also feasible.
- Evidence does not support concerns about endocrine imbalance or heart failure post-occlusion.
Conclusions:
- LAAO is an effective strategy for reducing thromboembolism risk in select AF patients.
- Surgical LAAO is safe, with various techniques available for personalized treatment.
- Current evidence refutes endocrine or heart failure concerns, but hemodynamic effects warrant further investigation.
Abstract:
Prophylactic left atrial appendage occlusion has been suggested as a means of reducing cardioembolism risk in patients with atrial fibrillation. Its clinical benefits have been discussed together with potential endocrine or hemodynamic adverse effects, with conflicting conclusions. We aimed to provide a thorough overview of the current literature and a recommendation for daily clinical decision-making. A comprehensive Medline search through PubMed was conducted to search for relevant articles, which were further filtered using the title and abstract. Sixty-five articles were selected as relevant to the topic. Concomitant left atrial appendage occlusion during cardiac surgery for other reasons is effective in terms of thromboembolism risk reduction in patients with a history of atrial fibrillation and higher CHA2DS2-VASc scores. Surgical occlusion is safe, and epicardial closure techniques are preferred. Thoracoscopic and transcatheter techniques are also feasible, and the individual treatment choice must be tailored to the patient. The concerns about endocrine imbalance or risk of heart failure after occlusion are not supported by evidence. Current evidence is conflicting with regard to hemodynamic consequences of appendage occlusion.
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