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ENDOVASCULAR METHODS FOR CLOSURE OF THE LEFT ATRIAL APPENDAGE IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION FOR STROKE PREVENTION

https://doi.org/10.20862/0042-4676-2018-99-2-108-114

Abstract

The paper presents an update on endovascular methods for closure of the left atrial appendage in order to prevent thromboembolic events in patients with nonvalvular atrial fibrillation. It analyzes the results of occlusion devices as an alternative to longterm anticoagulant therapy from the standpoint of evidencebased medicine, advantages, and features of design and implantation of occlusion devices, such as Watchman, Amplatzer, WaveCrest, and Lariat system. Literature searching was carried out using the databases PubMed and Scopus.

About the Authors

R. V. Guchaev
National Medical Research Center for Cardiology, Ministry of Health of the Russian Federation.
Russian Federation

Cardiologist.

ul. Tret’ya Cherepkovskaya, 15A, Moscow, 121552.



D. V. Pevzner
National Medical Research Center for Cardiology, Ministry of Health of the Russian Federation.
Russian Federation

MD, PhD, Cardiologist. 

ul. Tret’ya Cherepkovskaya, 15A, Moscow, 121552.



E. V. Merkulov
National Medical Research Center for Cardiology, Ministry of Health of the Russian Federation.
Russian Federation

MD, PhD, DSc, Senior Researcher.

ul. Tret’ya Cherepkovskaya, 15A, Moscow, 121552.



V. M. Mironov
National Medical Research Center for Cardiology, Ministry of Health of the Russian Federation.
Russian Federation

MD, PhD, Junior Researcher.

ul. Tret’ya Cherepkovskaya, 15A, Moscow, 121552.



N. S. Zhukova
National Medical Research Center for Cardiology, Ministry of Health of the Russian Federation.
Russian Federation

MD, PhD, Senior Researcher. 

ul. Tret’ya Cherepkovskaya, 15A, Moscow, 121552.



I. Z. Korobkova
National Medical Research Center for Cardiology, Ministry of Health of the Russian Federation.
Russian Federation

MD, PhD, Head of X-ray diagnostics department.

ul. Tret’ya Cherepkovskaya, 15A, Moscow, 121552.



References

1. Wilke T., Groth A., Mueller S., Pfannkuche M., Verheyen F., Linder R. et al. Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace. 2013; 15: 486–93.

2. Chugh S., Havmoeller R., Narayanan K., Singh D., Rienstra M., Benjamin E.J. etal. Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation. 2013; 129: 837–47.

3. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch. Intern. Med. 1994; 154 (13): 1449–57.

4. Hart R.G., Pearce L.A., Rothbart R.M., McAnulty J.H., Asinger R.W., HalperinJ.L. for the Stroke with intermittent atrial fibrillation: incidence and predictors during aspirin therapy. Stroke prevention in atrial fibrillation investigators. J. Am. Coll. Cardiol. 2000; 35: 183–7.

5. Blackshear J.L., Odell J.A. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann. Thorac. Surg. 1996; 61: 755–9.

6. Di Biase L., Santangeli P., Anselmino M., Mohanty P., Salvetti I., Gili S. et al. Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. J. Am. Coll. Cardiol. 2012; 60: 531–8.

7. Romero J., Perez I.E., Krumerman A., Garcia M.J., Lucariello R.J. Left atrial appendage closure devices. Clinical Medicine Insights. Cardiology. 2014; 8: 45–52.

8. Price M.J., Valderrábano M. Left atrial appendage closure to prevent stroke in patients with atrial fibrillation. Circulation. 2014; 130: 202–12.

9. Madden J. Resection of the left auricular appendix: a prophylaxis for recurrent arterial emboli. J. Am. Med. Assoc. 1949; 140: 769–72.

10. Dawson A.G., Asopa S., Dunning J. Should patients undergoing cardiac surgery with atrial fibrillation have left atrial appendage exclusion? Interact. Cardiovasc. Thorac. Surg. 2010; 10: 306–11.

11. Healey J.S., Crystal E., Lamy A., Teoh K., Semelhago L., Hohnloser S.H. et al. LeftAtrial Appendage Occlusion Study (LAAOS): results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke. Am. Heart J. 2005; 150: 288–93.

12. Whitlock R., Healey J., Vincent J. et al. Rationale and design of the Left Atrial Appendage Occlusion Study (LAAOS) III. Ann. Cardiothorac. Surg. 2014; 3 (1): 45–54.

13. Salzberg S.P., Plass A., Emmert M.Y., Desbiolles L., Alkadhi H., GrünenfelderJ., Genoni M. Left atrial appendage clip occlusion: early clinical results. J. Thorac. Cardiovasc. Surg. 2010; 139 (5): 1269–74.

14. Benussi S., Mazzone P., Maccabelli G., Vergara P., Grimaldi A., Pozzoli A. et al. Thoracoscopic appendage exclusionwith an Atriclip device as a solo treatment for focal atrial tachycardia. Circulation. 2011; 123: 1575–8.

15. Sievert H., Lesh M.D., Trepels T., Omran H., Bartorelli A., Della Bella P. et al. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience. Circulation. 2002; 105: 1887–9.

16. Ostermayer S.H., Reisman M., KramerP., Matthews R., Gray W., Block P.C. et al. 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. 2005; 46: 9–14.

17. Möbius-Winkler S., Sandri M., Mangner N., Lurz P., Dähnert I., Schuler G. et al. The WATCHMAN left atrial appendage closure device for atrial fibrillation. J. Vis. Exp. (60), e3671. DOI: 10.3791/3671 (2012)

18. Block P.C., Burstein S., Casale P.N., Kramer P.H., Teirstein P., Williams D.O. et al. Percutaneous left atrial appendage occlusion for patients in atrial fibrillation suboptimal for warfarin therapy: 5year results of the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) Study. JACC Cardiovasc. Interv. 2009; 2: 594–600.

19. Meier B., Blaauw Y., Khattab A.A., Lewanter T., Sievert H., Tondo C., Glikson M. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion. EHRA/EAPCI Consensus Statemen Europace Advance Access published August 29, 2014: 20–2.

20. Reddy V.Y., Neuzil P., Sick P., Sievert H. Minimizing the risk for pericardial effusion/tamponade during LA appendage closure using a next-generation watchman LAA closure device (Preliminary Results of the European EVOLVE Registry). Circulation. 2011; 124: A16825.

21. Sick P.B., Schuler G., Hauptmann K., Grube E., Yakubov S., Turi Z.G. et al. Initial worldwide experience with the WATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation. J. Am. Coll. Cardiol. 2007; 49: 1490–5.

22. Veinot J.P., Harrity P.J., Gentile F., Khandheria B.K., Bailey K.R., EickholtJ.T. et al. Anatomy of the normal left atrial appendage: a quantitative study of age-related changes in 500 autopsy hearts: implications for echocardiographic examination. Circulation. 1997; 96 (9): 3112–5.

23. Шахматова О.О. Эндоваскулярная окклюзия ушка левого предсердия устройством Watchman как альтернативный подход к профилактике тромбоэмболических осложнений у пациентов с фибрилляцией предсердий. Атеротромбоз. 2013; 2: 30–7. [Shakhmatova O.O. Endovascular left atrial appendage occlusion with a Watchman device as an alternative approach to preventing thromboembolic events in patients with atrial fibrillation. Atherothrombosis Journal. 2013; 2: 30–7 (in Russ.).]

24. Landmesser Ulf, Holmes D.R. Left atrial appendage closure: a percutaneous transcatheter approach for stroke prevention in atrial fibrillation. Eur. Heart J. 2012; 33: 698–704. DOI: 10.1093/eurheartj/ehr393

25. Reddy V.Y. Long term results of PROTECT AF: the mortality effects of left atrial appendage closure versus warfarin for stroke prophylaxis in AF. Presented at: Heart Rhythm Society 34th Annual Scientific Sessions; May 9, 2013; Denver, CO.

26. Holmes D.R., Kar S.K., Price M.J., Whisenant B., Sievert H., Doshi S.K. etal. Prospective randomized evaluation of the WATCHMAN LAA Closure Device in Patients with Atrial Fibrillation versus Long Term Warfarin Therapy trial. J. Am. Coll. Cardiol. 2014; 64: 1–12.

27. Reddy V.Y., Holmes D., Doshi S.K., Neuzil P., Kar S. Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry. Circulation. 2011; 123: 417–24.

28. Park J.W., Bethencourt A., Sievert H., Santoro G., Meier B., Walsh K. et al. Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation: initial European experience. Catheter. Cardiovasc. Interv. 2011; 77: 700–6.

29. Freixa X., Chan J., Tzikas A., Garceau P., Basmadjian A., Ibrahim R. The Amplatzer™ Cardiac Plug 2 for left atrial appendage occlusion: novel features andfirst-in-man experience. EuroIntervention. 2013; 8: 1094–8.

30. Meerkin D., Butnaru A., Dratva D., Bertrand O.F., Tzivoni D. Early safety of the Amplatzer Cardiac Plug for left atrial appendage occlusion. Int. J. Cardiol. 2013; 168: 3920–5.

31. Plicht B., Konorza T.F., Kahlert P., AlRashid F., Kaelsch H., Jánosi R.A. et al. Risk factors for thrombus formation on the Amplatzer Cardiac Plug after left atrial appendage occlusion. JACC Cardiovasc. Interv. 2013; 6: 606–13.

32. Lam Y.Y. A new left atrial appendage occluder (Lifetech LAmbre Device) for stroke prevention in atrial fibrillation. Cardiovasc. Revasc. Med. 2013; 14: 134–6.

33. Percutaneous left atrial appendage occlusion for stroke prevention in atrial fibrillation: an update. Open Heart. 2014; 1 (1): e000020. Published online 2014 Jun 6. DOI: 10.1136/openhrt-2013-000020

34. Toumanides S., Sideris E., Agricola T., Moulopoulos S. Transcatheter patch occlusion of the left atrial appendage using surgical adhesives in high-risk patients with atrial fibrillation. J. Am. Coll. Cardiol. 2011; 58: 2236–40.

35. Bartus K., Bednarek J., Myc J., KapelakB., Sadowski J., Lelakowski J. et al. Feasibility of closed-chest ligation of the left atrial appendage in humans. Heart Rhythm. 2011; 8: 188–93.

36. Le D.L., Khodjaev S.D., Morelli R.L. Percutaneous methods of left atrial appendage exclusion: an alternative to the internist. J. Commun. Hosp. Intern. Med. Perspect. 2014; 4 (1). DOI: 10.3402/jchimp.v4.22719

37. Price M.J., Burkhardt J.D., Di Biase L., Gibson D., Yakubov S., Schultz J. et al. Safety and early efficacy of the lariat procedure: results from the U.S. Left Atrial Appendage Ligation Consortium. J. Am. Coll. Cardiol. 2014; 64 (6): 565–72. DOI: 10.1016/j.jacc.2014.03.057

38. Bayard Y.L., Omran H., Neuzil P., Vejlstrup N., Jo/rgensen E., Pehrson S. et al. PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) for prevention of cardioembolic stroke in non-anticoagulation eligible atrial fibrillation patients: results from the European PLAATO study. EuroIntervention. 2010; 6: 220–6.

39. Reddy V., Doshi S., Sievert H., Buchbinder M., Neuzil P., Huber K. etal. Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3-year follow-up of the PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) Trial. Circulation. 2013; 127 (6): 720–9.


Review

For citations:


Guchaev R.V., Pevzner D.V., Merkulov E.V., Mironov V.M., Zhukova N.S., Korobkova I.Z. ENDOVASCULAR METHODS FOR CLOSURE OF THE LEFT ATRIAL APPENDAGE IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION FOR STROKE PREVENTION. Journal of radiology and nuclear medicine. 2018;99(2):108-114. (In Russ.) https://doi.org/10.20862/0042-4676-2018-99-2-108-114

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