Left atrial appendage closure devices
Left atrial appendage closure devices
Anticoagulation for prevention of stroke is a well established modality of treatment in atrial fibrillation. But a significant number of them have bleeding complications. Hence the option of left atrial appendage closure with multiple types of devices have been developed. Left atrial appendage with its sluggish flow is the most common location for thrombus formation in atrial fibrillation.
Following devices have been used with varying success:
Watchman
Amplatzer Cardiac Plug/Amulet
Lariat suture ligation
Atriclip
PROTECT-AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) [1] randomized patients with non valvular AF if they had at least one of stroke or transient ischaemic attack, congestive heart failure, diabetes, hypertension, or age 75 years or more. This was a randomized, multicentre non inferiority trial. Warfarin was eventually discontinued in the intervention group while it was continued with target INR 2 – 3 in the control group. Initial results showed non inferiority, with higher primary safety events in the intervention group. 2.3 year follow up data was reported later [2] was also similar. Warfarin was continued for about 45 days after device implantation followed by clopidogrel for 4.5 months and lifelong aspirin.
Amplatzer Cardiac Plug/Amulet real-world registry included 1,088 patients [3]. Of these patients with non valvular atrial fibrillation 82.8% had an absolute...
Source: Cardiophile MD - Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
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