INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

LEFT ATRIAL APPENDAGE CLOSURE: LONG-TERM OUTCOMES AND FOLLOW-UP

Dr. Murat Akdoğan

Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye

Akdoğan M. Left Atrial Appendage Closure: Long-Term Outcomes and Follow-Up. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.511-519.

ABSTRACT

This chapter focuses on the long-term outcomes and follow-up of left atrial appendage closure (LAAC) as a strategy to reduce stroke risk in patients with atrial fibrillation (AF). LAAC is a safe and effective option, especially for patients who are not candidates for long-term oral anticoagulation. Multiple studies have shown that LAAC decreases the risk of stroke and systemic embolism similarly to anticoagulant therapy while significantly lowering bleeding risks over time. The chapter also discusses post-procedural antithrombotic management strategies, challenges in patient selection, and important aspects of extended follow-up period. Ongoing research continues to enhance the efficacy and safety of LAAC, contributing to improved clinical outcomes.

Keywords: Left atrial appendage closure; Stroke risk reduction; Anticoagulant therapy; Thromboembolic events; Long-term outcomes; Antithrombotic therapy; Patient selection

Referanslar

  1. Banerjee A, Taillandier S, Olesen JB, Lane DA, Lallemand B, Lip GY, Fauchier L. Pattern of atrial fibrillation and risk of outcomes: the Loire Valley Atrial Fibrillation Project. Int J Cardiol. 2013 Sep 10;167(6):2682-7. Epub 2012 Jul 15. [Crossref]  [PubMed]
  2. Friberg L, Hammar N, Rosenqvist M. Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort of Atrial Fibrillation. Eur Heart J. 2010 Apr;31(8):967-75. Epub 2009 Jan 27. [Crossref]  [PubMed]
  3. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991 Aug;22(8):983-8. [Crossref]  [PubMed]
  4. Glikson M, Wolff R, Hindricks G, Mandrola J, Camm AJ, Lip GYH et al. ESC Scientific Document Group. EHRA/ EAPCI expert consensus statement on catheter-based left atrial appendage occlusion - an update. Europace. 2020 Feb 1;22(2):184. [Crossref]  [PubMed]
  5. Sievert H, Lesh MD, Trepels T, Omran H, Bartorelli A, Della Bella P et al. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience. Circulation. 2002 Apr 23;105(16):1887-9. [Crossref]  [PubMed]
  6. Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, et al. PROTECT AF Investigators. 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 Aug 15;374(9689):534-42. Erratum in: Lancet. 2009 Nov 7;374(9701):1596. [Crossref]  [PubMed]
  7. Holmes DR Jr, Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK, et al. Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014 Jul 8;64(1):1-12. Erratum in: J Am Coll Cardiol. 2014 Sep 16;64(11):1186. [Crossref]  [PubMed]
  8. Reddy VY, Doshi SK, Kar S, Gibson DN, Price MJ, Huber K et al. PREVAIL and PROTECT AF Investigators. 5-Year Outcomes After Left Atrial Appendage Closure: From the PREVAIL and PROTECT AF Trials. J Am Coll Cardiol. 2017 Dec 19;70(24):2964-2975. Epub 2017 Nov 4. [Crossref]  [PubMed]
  9. Jaiswal V, Ang SP, Shrestha AB, Wajid Z, Endurance EO, Ayoobkhan FS, et al. Amplatzer amulet versus watchman device for percutaneous left atrial appendage closure: A systematic review and meta-analysis. Medicine (Baltimore). 2023 Jun 30;102(26):e34185. [Crossref]  [PubMed]  [PMC]
  10. Osmancik P, Herman D, Neuzil P, Hala P, Taborsky M, Kala P, et al. PRAGUE-17 Trial Investigators. Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients With Atrial Fibrillation. J Am Coll Cardiol. 2020 Jun 30;75(25):3122-3135. [Crossref]  [PubMed]
  11. Osmancik P, Herman D, Neuzil P, Hala P, Taborsky M, Kala P, et al. PRAGUE-17 Trial Investigators. 4-Year Outcomes After Left Atrial Appendage Closure Versus Nonwarfarin Oral Anticoagulation for Atrial Fibrillation. J Am Coll Cardiol. 2022 Jan 4;79(1):1-14. Epub 2021 Nov 5. [Crossref]  [PubMed]
  12. Korsholm K, Damgaard D, Valentin JB, Packer EJS, Odenstedt J, Sinisalo J, et al. Left atrial appendage occlusion vs novel oral anticoagulation for stroke prevention in atrial fibrillation: rationale and design of the multicenter randomized occlusion-AF trial. Am Heart J. 2022 Jan;243:28-38. Epub 2021 Sep 17. [Crossref]  [PubMed]  [PMC]
  13. Huijboom M, Maarse M, Aarnink E, van Dijk V, Swaans M, van der Heijden J, et al. COMPARE LAAC: Rationale and design of the randomized controlled trial "COMPARing Effectiveness and safety of Left Atrial Appendage Occlusion to standard of care for atrial fibrillation patients at high stroke risk and ineligible to use oral anticoagulation therapy". Am Heart J. 2022 Aug;250:45-56. Epub 2022 May 7. [Crossref]  [PubMed]
  14. Park JW, Sievert H, Kleinecke C, et al. Left atrial appendage occlusion with lambre in atrial fibrillation: Initial European experience. Int J Cardiol. 2018;265:97-102. [Crossref]  [PubMed]
  15. Ali M, Rigopoulos AG, Mammadov M, et al. Systematic review on left atrial appendage closure with the LAmbre device in patients with non-valvular atrial fibrillation. BMC Cardiovasc Disord. 2020;20(1):78. [Crossref]  [PubMed]  [PMC]
  16. Wang G, Kong B, Liu Y, Huang H. Long-Term Safety and Efficacy of Percutaneous Left Atrial Appendage Closure with the LAmbre Device. J Interv Cardiol. 2020;2020:6613683. [Crossref]  [PubMed]  [PMC]
  17. Chen S, Chun KRJ, Bordignon S, et al. Left atrial appendage occlusion using LAmbre Amulet and Watchman in atrial fibrillation. J Cardiol. 2019;73(4):299-306. [Crossref]  [PubMed]
  18. Cruz-González I, González-Ferreiro R, Freixa X, Gafoor S, Shakir S, Omran H, et al. Left atrial appendage occlusion for stroke despite oral anticoagulation (resistant stroke). Results from the Amplatzer Cardiac Plug registry. Rev Esp Cardiol (Engl Ed). 2020 Jan;73(1):28-34. English, Spanish. Epub 2019 Apr 27. [Crossref]  [PubMed]
  19. Freeman JV, Higgins AY, Wang Y, Du C, Friedman DJ, Daimee UA, et al. Antithrombotic Therapy After Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation. J Am Coll Cardiol. 2022 May 10;79(18):1785-1798. [Crossref]  [PubMed]  [PMC]
  20. Patti G, Sticchi A, Verolino G, Pasceri V, Vizzi V, Brscic E et al. Safety and Efficacy of Single Versus Dual Antiplatelet Therapy After Left Atrial Appendage Occlusion. Am J Cardiol. 2020 Nov 1;134:83-90. Epub 2020 Aug 15. [Crossref]  [PubMed]
  21. Søndergaard L, Wong YH, Reddy VY, Boersma LVA, Bergmann MW, Doshi S, et al. Propensity-Matched Comparison of Oral Anticoagulation Versus Antiplatelet Therapy After Left Atrial Appendage Closure With WATCHMAN. JACC Cardiovasc Interv. 2019 Jun 10;12(11):1055-1063. [Crossref]  [PubMed]
  22. Perrotta L, Bordignon S, Dugo D, Fürnkranz A, Konstantinou A, Ricciardi G, et al. Complications From Left Atrial Appendage Exclusion Devices. J Atr Fibrillation. 2014 Jun 30;7(1):1034. [PubMed]  [PMC]
  23. Boersma LV, Schmidt B, Betts TR, Sievert H, Tamburino C, Teiger E, et al. Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry. Eur Heart J. 2016 Aug;37(31):2465-74. Epub 2016 Jan 27. [Crossref]  [PubMed]  [PMC]
  24. Tzikas A, Shakir S, Gafoor S, Omran H, Berti S, Santoro G, et al. Left atrial appendage occlusion for stroke prevention in atrial fibrillation: multicentre experience with the AMPLATZER Cardiac Plug. EuroIntervention. 2016 Feb;11(10):1170-9. [Crossref]  [PubMed]
  25. Nazir S, Ahuja KR, Kolte D, Isogai T, Michihata N, Saad AM, et al. Association of Hospital Procedural Volume With Outcomes of Percutaneous Left Atrial Appendage Occlusion. JACC Cardiovasc Interv. 2021 Mar 8;14(5):554-561. Epub 2021 Mar 1. [Crossref]  [PubMed]
  26. Cruz-González I, Korsholm K, Trejo-Velasco B, Thambo JB, Mazzone P, Rioufol G, et al. Procedural and Short-Term Results With the New Watchman FLX Left Atrial Appendage Occlusion Device. JACC Cardiovasc Interv. 2020 Dec 14;13(23):2732-2741. Epub 2020 Nov 11. [Crossref]  [PubMed]
  27. Boersma LV, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, et al. Evaluating Real-World Clinical Outcomes in Atrial Fibrillation Patients Receiving the WATCHMAN Left Atrial Appendage Closure Technology: Final 2-Year Outcome Data of the EWOLUTION Trial Focusing on History of Stroke and Hemorrhage. Circ Arrhythm Electrophysiol. 2019 Apr;12(4):e006841. [Crossref]  [PubMed]
  28. Simard T, Jung RG, Lehenbauer K, Piayda K, Pracoń R, Jackson GG, et al. Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion. J Am Coll Cardiol. 2021 Jul 27;78(4):297-313. [Crossref]  [PubMed]
  29. Lempereur M, Aminian A, Freixa X, Gafoor S, Kefer J, Tzikas A, et al. Device-associated thrombus formation after left atrial appendage occlusion: A systematic review of events reported with the Watchman, the Amplatzer Cardiac Plug and the Amulet. Catheter Cardiovasc Interv. 2017 Nov 1;90(5):E111-E121. Epub 2017 Feb 1. [Crossref]  [PubMed]
  30. Alkhouli M, Du C, Killu A, Simard T, Noseworthy PA, Friedman PA, et al. Clinical Impact of Residual Leaks Following Left Atrial Appendage Occlusion: Insights From the NCDR LAAC Registry. JACC Clin Electrophysiol. 2022 Jun;8(6):766-778. Epub 2022 Apr 3. [Crossref]  [PubMed]  [PMC]
  31. Aminian A, Lalmand J, Tzikas A, Budts W, Benit E, Kefer J. Embolization of left atrial appendage closure devices: A systematic review of cases reported with the watchman device and the amplatzer cardiac plug. Catheter Cardiovasc Interv. 2015 Jul;86(1):128-35. Epub 2015 Feb 25. Erratum in: Catheter Cardiovasc Interv. 2016 Jun;87(7):1362. [Crossref]  [PubMed]