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Left Atrial Appendage Closure (LAAC)

  • Anitha Varghese
  • Patrick CalvertEmail author
  • Peter F. Ludman
Chapter

Abstract

Atrial fibrillation (AF) affects approximately 15 million patients worldwide and carries an increased risk of stroke. It is estimated that 90 % of stroke comes from embolism of left atrial appendage (LAA) thrombus in non-valvular AF. The concept of mechanical occlusion of the LAA to reduce stroke risk has been refined over the years since it was first done surgically. Although anticoagulants such as warfarin are used to reduce stroke risk in AF and the new oral anticoagulants (novel oral anticoagulants or NOACs) are of benefit in non-valvular AF, bleeding remains a continuous risk in a significant minority of patients.

Keywords

Atrial Fibrillation Subdural Haematoma Systemic Embolism Left Atrial Appendage Reduce Stroke Risk 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 2.1

3D pre procedural TOE assessment. This demonstrated no LAA thrombus and a windsock morphology. There are three major LAA types; the windsock, chicken wing, and broccoli. The windsock has one dominant lobe of sufficient length as the primary structure and is the easiest for device closure. (AVI 2208 kb)

Video 2.2

Angiogram of LAA to demonstrate morphology. (AVI 900 kb)

Video 2.3a

Second deployment of device. (a) Device unsheathed in LAA (AVI 783 kb)

Video 2.3b

Second deployment of device. (b) Angiogram confirming device in position (AVI 689 kb)

Video 2.4

Device release from cable (AVI 670 kb)

Video 2.5

Post deployment TOE showing no colour leak (AVI 619 kb)

Recommended Reading

  1. 1.
    Holmes Jr DR, Kar S, Price MJ et al. Prospective randomized evaluation of the Watchman TM left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014;64:1–12.CrossRefPubMedGoogle Scholar
  2. 2.
    Holmes DR, Reddy VY, Turi ZG et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet. 2009;374:534–42.CrossRefPubMedGoogle Scholar
  3. 3.
    Reddy VY, Doshi SK, Sievert H et al. Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3-year follow-up of the PROTECT AF (Watchman TM left atrial appendage system for embolic protection in patients with atrial fibrillation) trial. Circulation. 2013;127:720–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Reddy VY, Sievert H, Halperin J et al. Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. JAMA. 2014;312:1988–98.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2017

Authors and Affiliations

  • Anitha Varghese
    • 1
  • Patrick Calvert
    • 2
    Email author
  • Peter F. Ludman
    • 3
  1. 1.LondonUK
  2. 2.Papworth Hospital NHS Foundation Trust, Papworth EverardCambridgeUK
  3. 3.Queen Elizabeth HospitalBirminghamUK

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