Jai-Wun Park1, Boris Leithäuser, Ulrich Gerk, Martin Vrsansky, Friedrich Jung. 1. Hoyerswerda Hospital, 1st Medical Department, Cardiology, Angiology, Nephrology, Academic Teaching Hospital of the Technical University of Dresden, Hoyerswerda, Germany. jai-wunpark@t-online.de
Abstract
PURPOSE: In more than 90% of patients with atrial fibrillation (AF), stroke is due to thrombotic embolization from the left atrial appendage (LAA). Transcatheter occlusion with percutaneous left atrial appendage transcatheter occlusion (PLAATO), a self-expanding, membrane- covered spherical nitinol cage, is feasible and an alternative to anticoagulation therapy. METHODS: This was a single-center prospective registry study for verification of stroke risk reduction in patients with AF 2 years after PLAATO. RESULTS: Seventy-three patients with AF (permanent 65, paroxysmal 8) in whom anticoagulation therapy was contraindicated or rejected underwent transcatheter LAA occlusion with PLAATO. One patient died periprocedurally due to implant embolization, and 1 patient underwent open-heart surgery because of implant instability. The remaining 71 patients were followed for 24 months. In 52 patients a stable anchoring of the PLAATO device without migration or dislocation was documented by transesophageal echocardiography (TEE). No thrombotic deposition was found on the LA luminal surface of the device. Statistically, in our patient cohort, 7 strokes would have been expected without any treatment within 24 months. In fact, no strokes were reported. Ten out of 71 patients died during follow up: 6 in our hospital and 4 at home. None of them died from a stroke. CONCLUSIONS: Ninety-seven percent of AF patients were successfully treated with PLAATO. After mechanical LAA occlusion, the 2-year risk of stroke in AF patients is markedly reduced. Therefore, this therapeutic concept is a clear alternative for patients with AF and contraindications for oral anticoagulation.
PURPOSE: In more than 90% of patients with atrial fibrillation (AF), stroke is due to thrombotic embolization from the left atrial appendage (LAA). Transcatheter occlusion with percutaneous left atrial appendage transcatheter occlusion (PLAATO), a self-expanding, membrane- covered spherical nitinol cage, is feasible and an alternative to anticoagulation therapy. METHODS: This was a single-center prospective registry study for verification of stroke risk reduction in patients with AF 2 years after PLAATO. RESULTS: Seventy-three patients with AF (permanent 65, paroxysmal 8) in whom anticoagulation therapy was contraindicated or rejected underwent transcatheter LAA occlusion with PLAATO. One patient died periprocedurally due to implant embolization, and 1 patient underwent open-heart surgery because of implant instability. The remaining 71 patients were followed for 24 months. In 52 patients a stable anchoring of the PLAATO device without migration or dislocation was documented by transesophageal echocardiography (TEE). No thrombotic deposition was found on the LA luminal surface of the device. Statistically, in our patient cohort, 7 strokes would have been expected without any treatment within 24 months. In fact, no strokes were reported. Ten out of 71 patients died during follow up: 6 in our hospital and 4 at home. None of them died from a stroke. CONCLUSIONS: Ninety-seven percent of AFpatients were successfully treated with PLAATO. After mechanical LAA occlusion, the 2-year risk of stroke in AFpatients is markedly reduced. Therefore, this therapeutic concept is a clear alternative for patients with AF and contraindications for oral anticoagulation.
Authors: Orly Goitein; Noam Fink; Ilan Hay; Elio Di Segni; Victor Guetta; David Goitein; Yafim Brodov; Eli Konen; Michael Glikson Journal: Int J Cardiovasc Imaging Date: 2017-01-09 Impact factor: 2.357