Potential applicability and utilization of left atrial appendage occlusion devices in patients with atrial fibrillation

Fountain, Rebecca; Holmes, David R.; Hodgson, Patricia; Chandrasekaran, Krishnaswamy; Tassel, Robert Van; Sick, Peter

doi:10.1016/j.ahj.2006.05.001

Cited by 30 publications

(14 citation statements)

References 7 publications

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“…On the other hand, in a screening study to assess the potential utility of the Watchman device, it was determined that 4 of 5 AF patients fit the PROTECT AF inclusion/exclusion criteria; thus, this trial is applicable to the vast majority of AF patients. 24 In addition, although the primary and secondary analyses were predefined, the assessment of outcomes on terminal therapy and evaluation of the functional end point of events on disability or death were designed post hoc and should therefore be considered exploratory.…”

Section: Study Limitationsmentioning

confidence: 99%

Percutaneous Left Atrial Appendage Closure for Stroke Prophylaxis in Patients With Atrial Fibrillation

et al. 2013

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) was conducted to determine whether percutaneous left atrial appendage closure with a filter device (Watchman) was noninferior to warfarin for stroke prevention in atrial fibrillation. Methods and Results-Patients (n=707) with nonvalvular atrial fibrillation and at least 1 risk factor (age >75 years, hypertension, heart failure, diabetes, or prior stroke/transient ischemic attack) were randomized to either the Watchman device (n=463) or continued warfarin (n=244) in a 2:1 ratio. After device implantation, warfarin was continued for ≈45 days, followed by clopidogrel for 4.5 months and lifelong aspirin. Study discontinuation rates were 15.3% (71/463) and 22.5% (55/244) for the Watchman and warfarin groups, respectively. The time in therapeutic range for the warfarin group was 66%. The composite primary efficacy end point included stroke, systemic embolism, and cardiovascular death, and the primary analysis was by intention to treat. After 1588 patient-years of follow-up (mean 2.3±1.1 years), the primary efficacy event rates were 3.0% and 4.3% (percent per 100 patient-years) in the Watchman and warfarin groups, respectively (relative risk, 0.71; 95% confidence interval, 0.44%-1.30% per year), which met the criteria for noninferiority (probability of noninferiority >0.999). There were more primary safety events in the Watchman group (5.5% per year; 95% confidence interval, 4.2%-7.1% per year) than in the control group (3.6% per year; 95% confidence interval, 2.2%-5.3% per year; relative risk, 1.53; 95% confidence interval, 0.95-2.70). Conclusions-The "local" strategy of left atrial appendage closure is noninferior to "systemic" anticoagulation with warfarin. PROTECT AF has, for the first time, implicated the left atrial appendage in the pathogenesis of stroke in atrial fibrillation.

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Section: Study Limitationsmentioning

confidence: 99%

Percutaneous Left Atrial Appendage Closure for Stroke Prophylaxis in Patients With Atrial Fibrillation

et al. 2013

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“…As noted above, previous series have not shown any significant arrhythmic or hemodynamic problems following left atrial appendage ligation or exclusion [3,12,13,17]. Of course, concerns regarding bleeding are valid, given the additional surgical site.…”

Section: Discussionmentioning

confidence: 88%

“…Therefore, identifying a low-risk procedure to reduce these problems and associated cost is obviously of great interest. A number of randomized trials are ongoing, including one investigating percutaneous closure (PROTECT AF) [17], one investigating concomitant surgical occlusion with coronary bypass surgery (LAAOS) [12], and the current trial.…”

Section: Discussionmentioning

confidence: 99%

Concurrent prophylactic left atrial appendage exclusion: results from a randomized controlled trial pilot study☆

Nagpal

Torracca

Fumero

et al. 2009

European Journal of Cardio-Thoracic Surgery

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“…What is even more important, this increased risk was independent from low risk assessed on the above-mentioned scales [8]. Recently there is much interest in LAA occlusion (LAAO) techniques with percutaneous devices such as WATCHMAN, LARIAT, Amplatzer or cardiac plug [10][11][12][13][14][15]. However, there are concerns about safety and efficacy of LAAO devices mainly connected with dislodgement of the device and complications related to low operator experience [12].…”

Section: Discussionmentioning

confidence: 99%

Cardiac surgery Left atrial appendage stapling during totally thoracoscopic ablation of long-standing lone persistent atrial fibrillation – lessons learnt

Witkowska¹,

Smoczyński²,

Drobiński³

et al. 2013

kitp

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Potential applicability and utilization of left atrial appendage occlusion devices in patients with atrial fibrillation

Cited by 30 publications

References 7 publications

Percutaneous Left Atrial Appendage Closure for Stroke Prophylaxis in Patients With Atrial Fibrillation

Percutaneous Left Atrial Appendage Closure for Stroke Prophylaxis in Patients With Atrial Fibrillation

Concurrent prophylactic left atrial appendage exclusion: results from a randomized controlled trial pilot study☆

Cardiac surgery Left atrial appendage stapling during totally thoracoscopic ablation of long-standing lone persistent atrial fibrillation – lessons learnt

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