Percutaneous left atrial appendage closure for stroke prevention

TY - JOUR

T1 - Percutaneous left atrial appendage closure for stroke prevention

AU - De Backer, Ole

AU - Loupis, Anastasia M

AU - Ihlemann, Nikolaj

AU - Vejlstrup, Niels G

AU - Søndergaard, Lars

AU - Franzen, Olaf W

PY - 2014/8

Y1 - 2014/8

N2 - INTRODUCTION: In atrial fibrillation (AF) patients with an increased stroke risk, oral anticoagulation (OAC) is the standard treatment for stroke prevention. However, this therapy carries a high risk of major bleeding. Percutaneous closure of the left atrial appendage (LAA) is suggested as an alternative option for stroke prevention in AF patients with contraindication(s) for OAC treatment.MATERIAL AND METHODS: A total of 42 patients underwent percutaneous LAA closure. In this report, we describe our experience with this procedure.RESULTS: The patients treated were AF patients with a high stroke risk (CHADS-VASc 4.5±1.4) and contra-indication(s) for OAC and/or a high bleeding risk (HAS-BLED 3.7±0.9). A history of intracerebral bleeding was the most common reason for LAA closure. Successful implantation was obtained in 41 of 42 patients. One major peri-procedural complication occurred; a major gastrointestinal bleeding immediately after the procedure. The mean duration of follow-up was 12.6 months. Both ischaemic stroke and bleeding occurred in one patient, resulting in an observed annual stroke and bleeding rate of 2.3%. This rate was lower than expected based on the CHADS-VASc (5.6%/year) and HAS-BLED (7.6%/year) for the patient cohort. At echo follow-up, incomplete LAA closure was seen in one case; device thrombosis was not observed.CONCLUSION: Our data confirm that percutaneous LAA closure can be a safe and effective strategy for stroke prevention in AF patients with an increased stroke and bleeding risk. However, long-term follow-up studies are needed before this procedure can be recommended for routine clinical use.FUNDING: Grant funding was received (St Jude Medical) for research, but there are no other competing interests.TRIAL REGISTRATION: Not relevant.

AB - INTRODUCTION: In atrial fibrillation (AF) patients with an increased stroke risk, oral anticoagulation (OAC) is the standard treatment for stroke prevention. However, this therapy carries a high risk of major bleeding. Percutaneous closure of the left atrial appendage (LAA) is suggested as an alternative option for stroke prevention in AF patients with contraindication(s) for OAC treatment.MATERIAL AND METHODS: A total of 42 patients underwent percutaneous LAA closure. In this report, we describe our experience with this procedure.RESULTS: The patients treated were AF patients with a high stroke risk (CHADS-VASc 4.5±1.4) and contra-indication(s) for OAC and/or a high bleeding risk (HAS-BLED 3.7±0.9). A history of intracerebral bleeding was the most common reason for LAA closure. Successful implantation was obtained in 41 of 42 patients. One major peri-procedural complication occurred; a major gastrointestinal bleeding immediately after the procedure. The mean duration of follow-up was 12.6 months. Both ischaemic stroke and bleeding occurred in one patient, resulting in an observed annual stroke and bleeding rate of 2.3%. This rate was lower than expected based on the CHADS-VASc (5.6%/year) and HAS-BLED (7.6%/year) for the patient cohort. At echo follow-up, incomplete LAA closure was seen in one case; device thrombosis was not observed.CONCLUSION: Our data confirm that percutaneous LAA closure can be a safe and effective strategy for stroke prevention in AF patients with an increased stroke and bleeding risk. However, long-term follow-up studies are needed before this procedure can be recommended for routine clinical use.FUNDING: Grant funding was received (St Jude Medical) for research, but there are no other competing interests.TRIAL REGISTRATION: Not relevant.

KW - Aged

KW - Aged, 80 and over

KW - Anticoagulants

KW - Atrial Appendage

KW - Atrial Fibrillation

KW - Female

KW - Humans

KW - Male

KW - Prosthesis Implantation

KW - Septal Occluder Device

KW - Stroke

M3 - Journal article

C2 - 25162439

SN - 2245-1919

VL - 61

SP - 1

EP - 4

JO - Danish Medical Journal

JF - Danish Medical Journal

IS - 8

M1 - A4879

ER -