Abstract
Atrial fibrillation is associated with a significant stroke risk. Though anticoagulation with warfarin reduces this risk, it also increases the likelihood of bleeding including intracranial hemorrhage and requires meticulous patient compliance and monitoring. Alternative anticoagulants have recently been demonstrated to be at least equivalent to warfarin but are accompanied by a similar bleeding risk. Therefore, the concept of percutaneous left atrial appendage closure has been pursued and, most recently, at least equivalency to anticoagulation was reported in a randomized trial comparing it to conventional anticoagulation with warfarin. This chapter outlines important technical considerations for implantation of a left atrial appendage occlusion device including the currently available WATCHMAN® device (Atritech Inc. Minneapolis, MN, USA) and Amplatzer® Cardiac Plug (AGA Medical Corporation, Minneapolis, MN, USA). It includes important tips regarding imaging, placement, and postprocedural care and outlines future perspectives for the concept of percutaneous left atrial appendage closure.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Blackshear JL, Odell JA (1996) Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg 61:755–759
Kanderian AS, Gillinov AM, Pettersson GB, Blackstone E, Klein AL (2008) Success of surgical left atrial appendage closure: assessment by transesophageal echocardiography. J Am Coll Cardiol 52:924–929
Sievert H, Lesh MD, Trepels T et al (2002) Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience. Circulation 105:1887–1889
Block PC, Burstein S, Casale PN et al (2009) Percutaneous left atrial appendage occlusion for patients in atrial fibrillation suboptimal for warfarin therapy: 5-year results of the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) Study. JACC Cardiovasc Interv 2:594–600
Holmes DR, Reddy VY, Turi ZG et al (2009) Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet 374:534–542
Park JW, Bethencourt A, Sievert H et al (2011) Left atrial appendage closure with amplatzer cardiac plug in atrial fibrillation: initial European experience. Catheter Cardiovasc Interv 77:700–706
Ostermayer SH, Reisman M, Kramer PH et al (2005) Percutaneous left atrial appendage transcatheter occlusion (PLAATO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: results from the international multi-center feasibility trials. J Am Coll Cardiol 46:9–14
Guazzi M, Arena R (2009) Endothelial dysfunction and pathophysiological correlates in atrial fibrillation. Heart 95:102–106
Muller I, Massberg S, Zierhut W et al (2002) Effects of aspirin and clopidogrel versus oral anticoagulation on platelet function and on coagulation in patients with nonvalvular atrial fibrillation (CLAFIB). Pathophysiol Haemost Thromb 32:16–24
Watson T, Shantsila E, Lip GY (2009) Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited. Lancet 373:155–166
Bruce CJ, Stanton CM, Asirvatham SJ et al (2011) Percutaneous epicardial left atrial appendage closure: intermediate-term results. J Cardiovasc Electrophysiol 22:64–70
In: Congenital and structural cardiac intervention. Frankfurt, Germany; 2011
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Bertog, S.C., Franke, J., Wunderlich, N., Sievert, H. (2013). Left Atrial Appendage Closure. In: Lanzer, P. (eds) Catheter-Based Cardiovascular Interventions. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27676-7_40
Download citation
DOI: https://doi.org/10.1007/978-3-642-27676-7_40
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-27675-0
Online ISBN: 978-3-642-27676-7
eBook Packages: MedicineMedicine (R0)