Left atrial appendage closure: a percutaneous transcatheter approach for stroke prevention in atrial fibrillation.

摘要: Atrial fibrillation is a frequent cause of stroke; in the elderly, more than 20% strokes are attributed to this common arrhythmia. Anticoagulation with warfarin reduces risk stroke by ∼60%; however, large proportion patients atrial do not receive treatment because relative/absolute contraindications. Moreover, often discontinue for variety reasons and chronic administration rates remain suboptimal. Although compliance anticoagulation may improve novel anticoagulants bleeding can be somewhat reduced when compared warfarin, there still progressive increase complications over time. Accordingly, new approaches prevention these being explored tested. In transoesophageal echocardiographic (TEE) studies, 90% thrombi were found left appendage (LAA) non-valvular fibrillation, transcatheter LAA closure developed examined as approach reduce patients. The PROTECT-AF study provides first evidence from randomized clinical trial that strategy occlusion using Watchman device non-inferior combined endpoint (mean CHADS(2) score 1.8). successfully occluded fulfilling TEE criteria (86%), was stopped after 45 days, followed aspirin clopidogrel 6 months randomization subsequently aspirin. PREVAIL further evaluating concept. Limited data available another system, Amplatzer Cardiac Plug (ACP) device, which ACP has been initiated. Left needs performed meticulous care experienced operators periprocedural such pericardial effusion or have documented. With increased operator experience technical improvements minimized.