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Percutaneous Left Atrial Appendage Closure: Review of Anatomy, Imaging, and Outcomes

  • Arrhythmia (R Kabra, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

Percutaneous left atrial appendage closure (LAAC) with WATCHMAN (Boston Scientific Inc.) has emerged as a viable non-pharmacological alternative for stroke prevention in several randomized clinical trials in high-risk AF patients with relative and absolute contraindications to anticoagulation. Several considerations include the proper selection of the patients, type of device, the antithrombotic therapy, and their duration post-procedurally.

Recent findings

The WATCHMAN device and the recently FDA-approved Abbott Amplatzer Amulet for stroke prevention in AF have shown satisfactory outcomes in stroke prevention. Multiple trials have studied the WATCHMAN device in detail in terms of efficacy and safety. However, there are no current papers that include all these studies and examine them together. In this manuscript, we take an in-depth look at these trials.

Summary

This manuscript reviews essential factors in the LAAC device’s selection process and evaluates the current studies that have assessed their efficacy coupled with various antithrombotic therapies post-implantation. Based on these trials, it can be demonstrated that the WATCHMAN device is an efficacious device for stroke prevention in patients who are not candidates for anticoagulation, and the recently approved Amulet device has shown comparable outcomes.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, 956 Court Avenue, Suite A312, Memphis, TN, 38163, USA

    Issa Pour-Ghaz MD, Mark R. Heckle MD, Miguel Maturana MD, Michael P. Seitz MD, Rami N. Khouzam MD, FACC & Rajesh Kabra MD, FACC

  2. Department of Internal Medicine, Aventura Hospital and Medical Center, Aventura, FL, USA

    Pegah Zare MD

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  1. Issa Pour-Ghaz MD
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  2. Mark R. Heckle MD
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  3. Miguel Maturana MD
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  6. Rami N. Khouzam MD, FACC
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  7. Rajesh Kabra MD, FACC
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Correspondence to Issa Pour-Ghaz MD.

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Appendix

Appendix

Fig. 1
figure 1

Pictorial representation of left atrial appendage morphologies. A Chicken Wing (classic shape). B Chicken Wing (short neck). C Cactus. D Windsock. E Cauliflower.

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Table 1 Studies involving WATCHMAN device and procedural success rates. DAPT, dual antiplatelet therapy; NOAC, non-vitamin K oral anticoagulants (NOAC)
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Table 2 List of studies looking at various anticoagulation and antiplatelet therapy after WATCHMAN device implantation. DAPT, dual antiplatelet therapy; SAPT, single antiplatelet therapy; NOAC, non-vitamin K oral anticoagulants; AC, anticoagulation; LMWH, low molecular weight heparin
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Pour-Ghaz, I., Heckle, M.R., Maturana, M. et al. Percutaneous Left Atrial Appendage Closure: Review of Anatomy, Imaging, and Outcomes. Curr Treat Options Cardio Med 24, 41–59 (2022). https://doi.org/10.1007/s11936-022-00958-1

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