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Netherlands Heart Journal logoLink to Netherlands Heart Journal
. 2003 Dec;11(12):506–509.

First Dutch experience with percutaneous left atrial appendage transcatheter occlusion

MF Scholten, LJ Jordaens, PA Cummins, PW Serruys
PMCID: PMC2499961  PMID: 25696171

Abstract

Background

Patients with atrial fibrillation (AF) have an increased risk of thromboembolic stroke, dependent on clinical variables. Oral anticoagulation significantly decreases the risk of stroke or embolism, but sometimes this is difficult to manage and may be contraindicated. Approximately 90% of atrial thrombi in nonrheumatic AF are found in the left atrial appendage (LAA). A new device has been developed which allows percutaneous LAA occlusion (PLAATO) and might be an alternative to oral anticoagulation. Feasibility in dogs and humans was described previously.

Methods and Results

As part of an international multicentre trial, three patients received a percutaneous transcatheter LAA occlusion device. Implantations were performed without general anaesthesia, guided by intracardiac and transoesophageal echocardiography and without major complications. The implantations were well tolerated by the patients, who entered a long-term follow-up to be compared with a historical control group.

Conclusion

Transseptal percutaneous LAA occlusion is feasible. Its role as an alternative to oral anticoagulation, however, needs to be further defined.

Keywords: atrial fibrillation, left atrial appendage, occluder, thromboembolic risk

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Al-Saady N. M., Obel O. A., Camm A. J. Left atrial appendage: structure, function, and role in thromboembolism. Heart. 1999 Nov;82(5):547–554. doi: 10.1136/hrt.82.5.547. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bonow R. O., Carabello B., de Leon A. C., Edmunds L. H., Jr, Fedderly B. J., Freed M. D., Gaasch W. H., McKay C. R., Nishimura R. A., O'Gara P. T. ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). J Heart Valve Dis. 1998 Nov;7(6):672–707. [PubMed] [Google Scholar]
  3. Connolly Stuart J. Preventing stroke in patients with atrial fibrillation: current treatments and new concepts. Am Heart J. 2003 Mar;145(3):418–423. doi: 10.1067/mhj.2003.84. [DOI] [PubMed] [Google Scholar]
  4. Frykman V., Beerman B., Rydén L., Rosenqvist M., Medical Products Agency. Swedish Society of Cardiology Management of atrial fibrillation: discrepancy between guideline recommendations and actual practice exposes patients to risk for complications. Eur Heart J. 2001 Oct;22(20):1954–1959. doi: 10.1053/euhj.2000.2300. [DOI] [PubMed] [Google Scholar]
  5. Gage B. F., Waterman A. D., Shannon W., Boechler M., Rich M. W., Radford M. J. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001 Jun 13;285(22):2864–2870. doi: 10.1001/jama.285.22.2864. [DOI] [PubMed] [Google Scholar]
  6. Goldstein L. B., Bertels C., Davis J. N. Interrater reliability of the NIH stroke scale. Arch Neurol. 1989 Jun;46(6):660–662. doi: 10.1001/archneur.1989.00520420080026. [DOI] [PubMed] [Google Scholar]
  7. Johnson W. D., Ganjoo A. K., Stone C. D., Srivyas R. C., Howard M. The left atrial appendage: our most lethal human attachment! Surgical implications. Eur J Cardiothorac Surg. 2000 Jun;17(6):718–722. doi: 10.1016/s1010-7940(00)00419-x. [DOI] [PubMed] [Google Scholar]
  8. Nakai Toshiko, Lesh Michael D., Gerstenfeld Edward P., Virmani Renu, Jones Russell, Lee Randall J. Percutaneous left atrial appendage occlusion (PLAATO) for preventing cardioembolism: first experience in canine model. Circulation. 2002 May 7;105(18):2217–2222. doi: 10.1161/01.cir.0000015605.30810.51. [DOI] [PubMed] [Google Scholar]
  9. Nakai Toshiko, Lesh Michael, Ostermayer Stefan, Billinger Kai, Sievert Horst. An endovascular approach to cardioembolic stroke prevention in atrial fibrillation patients. Pacing Clin Electrophysiol. 2003 Jul;26(7 Pt 2):1604–1606. doi: 10.1046/j.1460-9592.2003.t01-1-00238.x. [DOI] [PubMed] [Google Scholar]
  10. Odell J. A., Blackshear J. L., Davies E., Byrne W. J., Kollmorgen C. F., Edwards W. D., Orszulak T. A. Thoracoscopic obliteration of the left atrial appendage: potential for stroke reduction? Ann Thorac Surg. 1996 Feb;61(2):565–569. doi: 10.1016/0003-4975(95)00885-3. [DOI] [PubMed] [Google Scholar]
  11. 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 Jul 11;154(13):1449–1457. [PubMed] [Google Scholar]
  12. Sarich T. C., Osende J. I., Eriksson U. G., Fager G. B., Eriksson-Lepkowska M., Ohlsson L., Carlsson S., Wåhlander K., Gustafsson D., Badimon J. J. Acute antithrombotic effects of ximelagatran, an oral direct thrombin inhibitor, and r-hirudin in a human ex vivo model of arterial thrombosis. J Thromb Haemost. 2003 May;1(5):999–1004. doi: 10.1046/j.1538-7836.2003.00201.x. [DOI] [PubMed] [Google Scholar]
  13. Sievert Horst, Lesh Michael D., Trepels Thomas, Omran Heyder, Bartorelli Antonio, Della Bella Paola, Nakai Toshiko, Reisman Mark, DiMario Carlo, Block Peter. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience. Circulation. 2002 Apr 23;105(16):1887–1889. doi: 10.1161/01.cir.0000015698.54752.6d. [DOI] [PubMed] [Google Scholar]
  14. Stafford R. S., Singer D. E. Recent national patterns of warfarin use in atrial fibrillation. Circulation. 1998 Apr 7;97(13):1231–1233. doi: 10.1161/01.cir.97.13.1231. [DOI] [PubMed] [Google Scholar]
  15. Szili-Torok T., Kimman G., Theuns D., Res J., Roelandt J. R., Jordaens L. J. Transseptal left heart catheterisation guided by intracardiac echocardiography. Heart. 2001 Nov;86(5):E11–E11. doi: 10.1136/heart.86.5.e11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Wolf P. A., Dawber T. R., Thomas H. E., Jr, Kannel W. B. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology. 1978 Oct;28(10):973–977. doi: 10.1212/wnl.28.10.973. [DOI] [PubMed] [Google Scholar]

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