Left Atrial Appendage Exclusion: State-Of-The-Art

被引:45
作者
Cruz-Gonzalez, Ignacio [1 ]
Yan, Bryan P. [2 ,3 ]
Lam, Yat-Yin [2 ]
机构
[1] Univ Hosp Salamanca, Div Cardiol, Salamanca 37007, Spain
[2] Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China
[3] Monash Univ, Dept Epidemiol & Prevent Med, Melbourne, Vic 3004, Australia
关键词
left atrial appendage exclusion; atrial fibrillation; oral anticoagulation; stroke; HIGH-RISK PATIENTS; PREVENT STROKE; TRANSCATHETER OCCLUSION; PERCUTANEOUS CLOSURE; FIBRILLATION; ANTICOAGULATION; OBLITERATION; EXPERIENCE; MANAGEMENT; THERAPY;
D O I
10.1002/ccd.22344
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
It is postulated that the source of thromboembolism in 90% of patients with non-valvular atrial fibrillation (AF) arises from the left atrial appendage (LAA). Anticoagulation with warfarin is the standard medical therapy for stroke prevention in patients with AF. However, chronic warfarin therapy is contraindicated in 14 to 44% of patients with AF who are at risk for stroke. Mechanical exclusion of the LAA may prevent thrombus formation in the appendage and hence reduce the risk of stroke. Recently, several studies of percutaneous transcatheter delivery of dedicated LAA exclusion devices such as the PLAATO device, Watchman device and the Amplatzer cardiac plug, have shown encouraging results as an alternative to warfarin therapy for selected patients. This article aims to review the current evidence for LAA exclusion in patients with AF. (C) 2010 Wiley-Liss, Inc.
引用
收藏
页码:806 / 813
页数:8
相关论文
共 20 条
[1]   Thoracoscopic extracardiac obliteration of the left atrial appendage for stroke risk reduction in atrial fibrillation [J].
Blackshear, JL ;
Johnson, WD ;
Odell, JA ;
Baker, VS ;
Howard, M ;
Pearce, L ;
Stone, C ;
Packer, DL ;
Schaff, HV .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 42 (07) :1249-1252
[2]   Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation [J].
Blackshear, JL ;
Odell, JA .
ANNALS OF THORACIC SURGERY, 1996, 61 (02) :755-759
[3]   Percutaneous Left Atrial Appendage Occlusion for Patients in Atrial Fibrillation Suboptimal for Warfarin Therapy 5-Year Results of the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) Study [J].
Block, Peter C. ;
Burstein, Steven ;
Casale, Paul N. ;
Kramer, Paul H. ;
Teirstein, Paul ;
Williams, David O. ;
Reisman, Mark .
JACC-CARDIOVASCULAR INTERVENTIONS, 2009, 2 (07) :594-600
[4]   Adequacy of anticoagulation in patients with atrial fibrillation coming to a hospital [J].
Bungard, TJ ;
Ackman, ML ;
Ho, G ;
Tsuyuki, RT .
PHARMACOTHERAPY, 2000, 20 (09) :1060-1065
[5]  
Chiam Paul T L, 2008, J Invasive Cardiol, V20, pE109
[6]   ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation -: executive summary -: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society [J].
Fuster, Valentin ;
Ryden, Lars E. ;
Cannom, David S. ;
Crijns, Harry J. ;
Curtis, Anne B. ;
Ellenbogen, Kenneth A. ;
Halperin, Jonathan L. ;
Le Heuzey, Jean-Yves ;
Kay, G. Neal ;
Lowe, James E. ;
Olsson, S. Bertil ;
Prystowsky, Eric N. ;
Tamargo, Juan Luis ;
Wann, Samuel ;
Priori, Silvia G. ;
Blanc, Jean-Jacques ;
Budaj, Andrzej ;
Camm, John ;
Dean, Veronica ;
Deckers, Jaap W. ;
Despres, Catherine ;
Dickstein, Kenneth ;
Lekakis, John ;
McGregor, Keith ;
Metra, Marco ;
Morais, Joao ;
Osterspey, Ady ;
Tamargo, Juan Luis ;
Zamorano, Jose Luis ;
Smith, Sidney C. ;
Jacobs, Alice K. ;
Adams, Cynthia D. ;
Anderson, Jeffery L. ;
Antman, Elliott M. ;
Halperin, Jonathan L. ;
Hunt, Sharon Ann ;
Nishimura, Rick ;
Ornato, Joseph P. ;
Page, Richard L. ;
Riegel, Barbara .
EUROPEAN HEART JOURNAL, 2006, 27 (16) :1979-2030
[7]   Prevalence of diagnosed atrial fibrillation in adults - National implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study [J].
Go, AS ;
Hylek, EM ;
Phillips, KA ;
Chang, YC ;
Henault, LE ;
Selby, JV ;
Singer, DE .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 285 (18) :2370-2375
[8]   Meta-analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation [J].
Hart, Robert G. ;
Pearce, Lesly A. ;
Aguilar, Maria I. .
ANNALS OF INTERNAL MEDICINE, 2007, 146 (12) :857-867
[9]   Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial [J].
Holmes, David R. ;
Reddy, Vivek Y. ;
Turi, Zoltan G. ;
Doshi, Shephal K. ;
Sievert, Horst ;
Buchbinder, Maurice ;
Mullin, Christopher M. ;
Sick, Peter .
LANCET, 2009, 374 (9689) :534-542
[10]   Surgical left atrial appendage ligation is frequently incomplete: a transesophageal echocardiographic study [J].
Katz, ES ;
Tsiamtsiouris, T ;
Applebaum, RM ;
Schwartzbard, A ;
Tunick, PA ;
Kronzon, I .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 36 (02) :468-471