Percutaneous left atrial appendage occlusion

Authors: Petriy V.V., Maksimkin D.A., Petriy V.V., Shugushev Z.Kh.

Company: 1 Peoples’ Friendship University of Russia (RUDN University), Moscow, Russian Federation
2 Federal State Autonomous Institution “National Medical Research Center" Treatment and Rehabilitation Center”, Moscow, Russian Federation

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Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2022-16-2-189-198

For citation: Petriy V.V., Maksimkin D.A., Petriy V.V., Shugushev Z. Kh. Percutaneous left atrial appendage occlusion. Creative Cardiology. 2022; 16 (2): 189–198 (in Russ.). DOI: 10.24022/1997-3187-2022-16-2-189-198

Received / Accepted:  03.03.2022 / 20.06.2022

Keywords: atrial fibrillation left atrial appendage occlusion anticoagulant therapy thromboembolic complications ischemic stroke hemorrhagic complications leaks

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Abstract

Atrial fibrillation (AF) is the most common heart rhythm disturbance in the world. The presence of AF is associated with an increased risk of death, ischemic stroke, systemic embolism, myocardial infarction and heart failure. Cardioembolic stroke is considered to be the most feared complication of AF, which is accompanied by greater disability and mortality than other types of ischemic stroke. Anticoagulant therapy contributes to a decrease in the risk of thromboembolic complications, but patient adherence to it remains low; in addition, anticoagulants significantly increase the risk of hemorrhagic complications. It should be noted that about 2% of patients have absolute contraindications to anticoagulant therapy. In the vast majority of cases, the left atrial appendage is the main thrombogenic heart cavity in AF patients. Percutaneous left atrial appendage occlusion is aimed at preventing both thromboembolic and hemorrhagic complications, since after successful exclusion of this heart cavity from the systemic circulation, it is possible to use more sparing antithrombotic therapy regimens up to the complete abolition of anticoagulant therapy. This article presents a literature review of current studies on the problem of the left atrial appendage isolation, analyzes the main advantages and disadvantages of this technique, and identifies possible directions for future research.

References

  1. Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström-Lundqvist C. et al.; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 2021; 42 (5): 373–498. DOI: 10.1093/eurheartj/ehaa612
  2. Krijthe B.P., Kunst A., Benjamin E.J., Lip G.Y., Franco O.H., Hofman A. et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur. Heart J. 2013; 34 (35): 2746–51. DOI: 10.1093/eurheartj/eht280
  3. Benjamin E.J., Muntner P., Alonso A., Bittencourt M.S., Callaway C.W., Carson A.P. et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019; 139 (10): e56–e528. DOI: 10.1161/CIR.0000000000000659
  4. Quinn G.R., Severdija O.N., Chang Y., Singer D.E. Wide variation in reported rates of stroke across cohorts of patients with atrial fibrillation. Circulation. 2017; 135: 208–19. DOI: 10.1161/CIRCULATIONAHA.116.024057
  5. Lim H.S., Schultz C., Dang J., Alasady M., Lau D.H., Brooks A.G. et al. Time course of inflammation, myocardial injury, and prothrombotic response after radiofrequency catheter ablation for atrial fibrillation. Circ. Arrhythm. Electrophysiol. 2014; 7 (1): 83–9. DOI: 10.1161/CIRCEP.113.000876
  6. Meier B., Stegink W., Tzikas A. History of Percutaneous Left Atrial Appendage Occlusion with AMPLATZER Devices. Interv. Cardiol. Clin. 2018; 7 (2): 151–8. DOI: 10.1016/j.iccl.2017.12.007
  7. Lip G.Y., Frison L., Halperin J.L., Lane D.A. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke. 2010; 41 (12): 2731–8. DOI: 10.1161/STROKEAHA.110.590257
  8. Barra S., Providência R. Anticoagulation in atrial fibrillation. Heart. 2021; 107 (5): 419–27. DOI: 10.1136/heartjnl-2020-316728
  9. Oake N., Fergusson D.A., Forster A.J., van Walraven C. Frequency of adverse events in patients with poor anticoagulation: a meta-analysis. CMAJ. 2007; 176 (11): 1589–94. DOI: 10.1503/cmaj.061523
  10. Ruff C.T., Giugliano R.P., Braunwald E., Hoffman E.B., Deenadayalu N., Ezekowitz M.D. et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014; 383 (9921): 955–62. DOI: 10.1016/S0140-6736(13)62343-0
  11. Boytsov S.A., Lukyanov M.M., Yakushin S.S., Martsevich S.Yu., Vorobyov A.N., Zagrebelny A.V. et al. Outpatient register of cardiovascular diseases in the Ryazan Region (RECVASA): principal tasks, experience of development and first results. Cardiovascular Therapy and Prevention. 2014; 13 (6): 44–50 (in Russ.). DOI: 10.15829/1728- 8800-2014-6-3-8
  12. Steinberg B.A., Greiner M.A., Hammill B.G., Cur-tis L.H., Benjamin E.J., Heckbert S.R., Piccini J.P. Contraindications to anticoagulation therapy and eligibility for novel anticoagulants in older patients with atrial fibrillation. Cardiovasc. Ther. 2015; 33 (4): 177–83. DOI: 10.1111/1755- 5922.12129
  13. Blackshear J.L., Odell J.A. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann. Thorac. Surg. 1996; 61: 755–9.
  14. Cresti A., García-Fernández M.A., Sievert H., Mazzone P., Baratta P., Solari M. et al. Prevalence of extra-appendage thrombosis in non-valvular atrial fibrillation and atrial flutter in patients undergoing cardioversion: a large transoesophageal echo study. Euro Intervention. 2019; 15 (3): e225–e230. DOI: 10.4244/EIJ-D-19-00128
  15. Whitlock R.P., Belley-Cote E.P., Paparella D., Healey J.S., Brady K., Sharma M. et al.; LAAOS III Investigators. Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke. N. Engl. J. Med. 2021; 384 (22): 2081–91. DOI: 10.1056/NEJMoa2101897
  16. Musat D., Mittal S. LARIAT Trial Updates. J. Atr. Fibrillation. 2018; 11 (1): 1806. DOI: 10.4022/jafib.1806
  17. Lakkireddy D., Thaler D., Ellis C.R., Swarup V., Sondergaard L., Carroll J. et al. Amplatzer Amulet Left Atrial Appendage Occluder Versus Watchman Device for Stroke Prophylaxis (Amulet IDE): a randomized, controlled trial. Circulation. 2021; 144 (19): 1543–52. DOI: 10.1161/CIRCULATIONAHA.121.057063
  18. Holmes D.R. Jr, Doshi S.K., Kar S., Price M.J., Sanchez J.M., Sievert H. et al. Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation: a patientlevel meta-analysis. J. Am. Coll. Cardiol. 2015; 65 (24): 2614–23. DOI: 10.1016/j.jacc. 2015.04.025
  19. Aminian A., Al Hage E., Saw J. Are patients with long-standing persistent atrial fibrillation at higher risk with left atrial appendage occlusion? JACC Cardiovasc. Interv. 2019; 12 (11): 1027–9. DOI: 10.1016/j.jcin.2019.04.022
  20. Nguyen A., Gallet R., Riant E., Deux J.F., Boukantar M., Mouillet G. et al. Peridevice Leak After Left Atrial Appendage Closure: Incidence, Risk Factors, and Clinical Impact. Can. J. Cardiol. 2019; 35 (4): 405–12. DOI: 10.1016/j.cjca.2018.12.022
  21. Sivasambu B., Arbab-Zadeh A., Hays A., Calkins H., Berger R.D. Delayed endothelialization of watchman device identified with cardiac CT. J. Cardiovasc. Electrophysiol. 2019; 30 (8): 1319–24. DOI: 10.1111/jce.14053
  22. Granier M., Laugaudin G., Massin F., Cade S., Winum P.F., Freitag C., Pasquie J.L. Occurrence of Incomplete Endothelialization Causing Residual Permeability After Left Atrial Appendage Closure. J. Invasive Cardiol. 2018; 30 (7): 245–50.
  23. Alkhouli M., Busu T., Shah K., Osman M., Alqahtani F., Raybuck B. Incidence and Clinical Impact of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion: A Meta-Analysis. JACC Clin. Electrophysiol. 2018; 4 (12): 1629–37. DOI: 10.1016/j.jacep.2018.09.007
  24. Osmancik P., Herman D., Neuzil P., Hala P., Taborsky M., Kala P. et al.; PRAGUE-17 Trial Investigators. Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients With Atrial Fibrillation. J. Am. Coll. Cardiol. 2020; 75 (25): 3122–35. DOI: 10.1016/j.jacc.2020.04.067
  25. Lee O.H., Kim Y.D., Kim J.S., Son N.H., Pak H.N., Joung B. et al. Percutaneous Left Atrial Appendage Occlusion Yields Favorable Neurological Outcomes in Patients with Non-Valvular Atrial Fibrillation. Korean Circ. J. 2021; 51 (7): 626–38. DOI: 10.4070/kcj.2020.0527
  26. Freeman J.V., Varosy P., Price M.J., Slotwiner D., Kusumoto F.M., Rammohan C. et al. The NCDR Left Atrial Appendage Occlusion Registry. J. Am. Coll. Cardiol. 2020; 75 (13): 1503–18. DOI: 10.1016/j.jacc.2019.12.040
  27. Kar S., Doshi S.K., Sadhu A., Horton R., Osorio J., Ellis C. et al.; PINNACLE FLX Investigators. Primary Outcome Evaluation of a Next-Generation Left Atrial Appendage Closure Device: Results From the PINNACLE FLX Trial. Circulation. 2021; 143 (18): 1754–62. DOI: 10.1161/CIRCULATIONAHA.120.050117

About Authors

  • Vladimir V. Petriy, Postgraduate; ORCID
  • Daniil A. Maksimkin, Cand. Med. Sci., Associate Professor; ORCID
  • Vladimir V. Petriy, Dr. Med. Sci., Head of the Department; ORCID
  • Zaurbek Kh. Shugushev, Dr. Med. Sci., Associate Professor, Chief of Chair; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery