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Percutaneous left atrial appendage occlusion in the prevention of stroke in atrial fibrillation: a systematic review

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Abstract

Atrial fibrillation is commonly coexistent with heart failure, and the management of the heart failure patient would be incomplete without an appreciation for atrial fibrillation management. There are many complications associated with oral anticoagulation in the prevention of stroke related to atrial fibrillation. In recent years, the advent of several percutaneous left atrial appendage (LAA) occlusion/closure strategies has sought to provide an alternative treatment modality. Here, we systematically review the published literature to investigate the efficacy and safety of percutaneous LAA occlusion/closure devices. We searched PubMed, EMBASE, Cochrane database of systematic reviews, and the FDA Medical Devices database. Using prespecified criteria, we identified studies of the Amplatzer Cardiac Plug (St. Jude Medical), Amplatzer Amulet (St. Jude Medical), Lariat suture delivery device (SentreHeart), and Watchman device (Boston Scientific). We analyzed 2 randomized controlled trials (RCT) and 15 non-randomized registries that satisfied the study criteria. The two RCT both studied the Watchman device versus standard warfarin therapy; the studies indicate that the Watchman may be non-inferior to warfarin. Long-term efficacy outcomes for the Watchman device are promising. Data regarding the Amplatzer Cardiac Plug, Amplatzer Amulet, and Lariat suture delivery device are limited by the paucity of RCT data. High-quality prospective research is needed to directly compare LAA occlusion/closure strategies against one another as well as versus the direct oral anticoagulation medications. Data regarding the role of LAA occlusion in the heart failure population are lacking.

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Acknowledgments

Dr. Biton is a Mirowski Moss Career Development Awardee.

Dr. Mansour is a consultant for Boston Scientific, Abbott Laboratories, SentreHeart, Medtronic, and Biosense Webster. He has received research grants from St. Jude Medical, SentreHeart, Medtronic, and Biosense Webster.

Dr. Heist is a consultant for Boston Scientific, Biotronik, Pfizer, and Abbott Laboratories. He has received research grants from Boston Scientific and St. Jude Medical.

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Authors and Affiliations

  1. Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Jayson R. Baman

  2. University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Jayson R. Baman & Yitschak Biton

  3. Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Moussa Mansour, E. Kevin Heist & Yitschak Biton

  4. Department of Cardiology, University of Rochester, Rochester, NY, USA

    David T. Huang & Yitschak Biton

  5. Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA

    Yitschak Biton

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Baman, J.R., Mansour, M., Heist, E.K. et al. Percutaneous left atrial appendage occlusion in the prevention of stroke in atrial fibrillation: a systematic review. Heart Fail Rev 23, 191–208 (2018). https://doi.org/10.1007/s10741-018-9681-4

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