Page 7 - Journal of Structural Heart Disease Volume 2, Issue 1

Review Article
Journal of Structural Heart Disease, February 2016, Volume 2, Issue 1: 1-14
DOI: http://dx.doi.org/10.12945/j.jshd.2015.006.14
Left Atrial Appendage Closure
Where Do We Stand Now?
J. Mauricio Sánchez, MD1* and David R. Holmes, Jr., MD2
1 Department of Cardiac Electrophysiology, The Heart Health Center, Mercy Clinic, St. Louis, Missouri, USA 2 Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
Received: October 13, 2014 Accepted: January 8, 2015 Published online: February 2016
Abstract
Atrial brillation is the most common arrhythmia with signi cant morbidity and mortality. The most feared complication of atrial brillation remains stroke. While anticoagulation remains the cornerstone of stroke prevention in patients with atrial brillation, patients continue to be under treated due to misinformation, intolerance, as well as relative and absolute contrain- dications. The left atrial appendage has been implicat- ed in thrombus formation in patients with atrial bril- lation. Left atrial appendage closure has been devised as an alternative strategy for decreasing stroke risk in patients with atrial brillation. Percutaneous left atri- al appendage closure is currently being developed as a possible alternative to anticoagulation in patients at high risk for stroke especially among patients with relative or absolute contraindications to long-term an- ticoagulation. The PROTECT AF trials provides the rst randomized, controlled trial data demonstrating proof of concept of left atrial appendage closure with the WATCHMAN device. Further data are explored in this review. Limited data are available with other devices. However, several devices are promising entries into the realm of left atrial appendage closure o ering options to an under treated patient population.
Copyright © 2016 Science International Corp.
Key Words
Atrial Fibrillation • Left atrial appendage • Left atrial appendage closure • Stroke • Thromboembolism • Bleeding
Introduction
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Atrial brillation (AF) is the most common arrhyth- mia, with an overall incidence of 0.4% to 1% in the gen- eral population [1-3]. The prevalence of AF increases with age. Given an aging population, the number of patients with AF is likely to increase in the near future. The estimated prevalence in 2010 ranged between 2.1 million and 6.1 million. By 2050, this is projected to increase to between 5.6 and 12 million patients [4], which will present signi cant challenges for health care delivery. AF results in chaotic atrial contraction and subsequent loss atrial transport function, which impairs left ventricular lling and promotes stasis. The resultant symptoms can range from absent to severe. AF is associated with signi cant increase in morbidity including congestive heart failure [5], dementia [6], and signi cant increase in mortality. The most feared complication of AF is stroke from thromboembo- lism. Patients with AF are at a ve times higher risk of stroke [7]. This risk increases with age [8]. Strokes in AF patients are often more severe than in non-AF related strokes [9].
Anticoagulation with vitamin K antagonists has been the cornerstone of stroke prevention in AF pa- tients at high risk for embolic stroke. Vitamin K an- tagonists have been shown to decrease incidence of thromboembolic stroke in these patients as well as
*Corresponding Author:
J. Mauricio Sánchez, MD
Department of Cardiac Electrophysiology
The Heart Health Center
West Wing, Suite 170, St. Louis, MO, 63141
Tel.: +1 314 991 6969; Fax: +1 314 997 6969; E-Mail: Jsanchez@Hearthealthcenter.com