Left atrial appendage closure: A new technique for clinical practice

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Presentation transcript:

Left atrial appendage closure: A new technique for clinical practice A John Camm, MD, FHRS, Antonio Colombo, MD, Giorgio Corbucci, PhD, Luigi Padeletti, MD Heart Rhythm Volume 11, Issue 3, Pages 514-521 (March 2014) DOI: 10.1016/j.hrthm.2013.11.030 Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 1 A: PLAATO. B: Amplatzer cardiac plug. C: WATCHMAN device, D: LARIAT. (From Chatterjee S, Alexander JC, Pearson PJ, Feldman T. Left atrial appendage occlusion: lessons learned from surgical and transcatheter experiences. Reproduced from Ann Thorac Surg 2011;92:2283–2292.) Heart Rhythm 2014 11, 514-521DOI: (10.1016/j.hrthm.2013.11.030) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 2 Endothelialization of the WATCHMAN device 9 months after the procedure. (From Sick PB, Schuler G, Holmes D, et al. Initial worldwide experience with the WATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation. Reproduced from J Am Coll Cardiol 2007;49:1490–1495.) Heart Rhythm 2014 11, 514-521DOI: (10.1016/j.hrthm.2013.11.030) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 3 Kaplan-Meier curves of incidence of study end-points in intervention and control groups for the PROTECT-AF trial. (From Holmes DR, Reddy VY, Sick P, et al; PROTECT AF Investigators. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomized non-inferiority trial. Reproduced from Lancet 2009;374:534–542.32) Heart Rhythm 2014 11, 514-521DOI: (10.1016/j.hrthm.2013.11.030) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 4 Observed rate of ischemic stroke in the ASAP registry (1.7%) compared to the expected event rate in patients with a similar CHADS2 score treated with aspirin (7.3%) and if clopidogrel also was used (5.0%). (From Reddy VY, Möbius-Winkler S, Sievert H, et al. Left atrial appendage closure with the Watchman device in patients with a contraindication for oral anticoagulation: ASA Plavix Feasibility Study with Watchman Left Atrial Appendage Closure Technology (ASAP Study). Reproduced from J Am Coll Cardiol 2013;61:2551–2556.36). Heart Rhythm 2014 11, 514-521DOI: (10.1016/j.hrthm.2013.11.030) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 5 Main conditions when left atrial appendage closure (LAAC) alternative can be evaluated. TIA = transient ischemic attack. Heart Rhythm 2014 11, 514-521DOI: (10.1016/j.hrthm.2013.11.030) Copyright © 2014 Heart Rhythm Society Terms and Conditions