Citation : Sven Mobius-Winkler, Ingo Dahnert, Gerhard C. Schuler and Peter B. Sick.Percutaneous Left Atrial Appendage Exclusion Therapy: Who, Why and How? .JAFIB.2009 October;Volume 1 Issue(9): 519-530.
The diagnosis of atrial fibrillation (AF) significantly increases the risk of having cardio embolic events. Cerebrovascular events are still a leading cause of death and disability worldwide. Current guidelines recommend an antithrombotic regimen to prevent thromboembolism in medium and high risk patients with AF. However, a substantial number of patients are not eligible for this therapy. Therefore, an exclusion of the left atrial appendage (LAA) from circulation seems to be an alternative strategy for stroke prevention in AF. This review focuses on the different strategies for LAA exclusion with a special focus on the WATCHMAN®-device.
Two devices are currently in use for percutaneous transcatheter occlusion of the LAA: the WATCHMAN®-device and the AMPLATZER®–Cardiac plug. Only for the WATCHMAN®-device safety, feasibility and non inferiority data compared to standard therapy data are currently available.
Additionally, about 200 patients at high risk for thromboembolic stroke and contraindications for oral anticoagulation therapy received the PLAATO® –device which is currently off the market.
The WATCHMAN®-device was implanted in 800 patients that were eligible for long-term anticoagulation therapy with a moderate risk for thromboembolic stroke due to non-valvular AF.
Current evidence indicates an equivalent risk of stroke compared to oral anticoagulation with a reduced rate of bleeding complications at least for the WATCHMAN®-device. Hence, another therapeutic option now is available to prevent thrombembolic events in patients with atrial fibrillation not suitable for medical anticoagulation therapy.
Key Words : atrial fibrillation, stroke, left atrial appendage, WATCHMAN® - device, Amplatzer® septal occluder, Amplatzer® cardiac plug
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