Percutaneous left atrial appendage closure for stroke prevention
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Percutaneous left atrial appendage closure for stroke prevention. / De Backer, Ole; Loupis, Anastasia M; Ihlemann, Nikolaj; Vejlstrup, Niels G; Søndergaard, Lars; Franzen, Olaf W.
I: Danish Medical Journal, Bind 61, Nr. 8, A4879, 08.2014, s. 1-4.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Percutaneous left atrial appendage closure for stroke prevention
AU - De Backer, Ole
AU - Loupis, Anastasia M
AU - Ihlemann, Nikolaj
AU - Vejlstrup, Niels G
AU - Søndergaard, Lars
AU - Franzen, Olaf W
PY - 2014/8
Y1 - 2014/8
N2 - INTRODUCTION: In atrial fibrillation (AF) patients with an increased stroke risk, oral anticoagulation (OAC) is the standard treatment for stroke prevention. However, this therapy carries a high risk of major bleeding. Percutaneous closure of the left atrial appendage (LAA) is suggested as an alternative option for stroke prevention in AF patients with contraindication(s) for OAC treatment.MATERIAL AND METHODS: A total of 42 patients underwent percutaneous LAA closure. In this report, we describe our experience with this procedure.RESULTS: The patients treated were AF patients with a high stroke risk (CHADS-VASc 4.5±1.4) and contra-indication(s) for OAC and/or a high bleeding risk (HAS-BLED 3.7±0.9). A history of intracerebral bleeding was the most common reason for LAA closure. Successful implantation was obtained in 41 of 42 patients. One major peri-procedural complication occurred; a major gastrointestinal bleeding immediately after the procedure. The mean duration of follow-up was 12.6 months. Both ischaemic stroke and bleeding occurred in one patient, resulting in an observed annual stroke and bleeding rate of 2.3%. This rate was lower than expected based on the CHADS-VASc (5.6%/year) and HAS-BLED (7.6%/year) for the patient cohort. At echo follow-up, incomplete LAA closure was seen in one case; device thrombosis was not observed.CONCLUSION: Our data confirm that percutaneous LAA closure can be a safe and effective strategy for stroke prevention in AF patients with an increased stroke and bleeding risk. However, long-term follow-up studies are needed before this procedure can be recommended for routine clinical use.FUNDING: Grant funding was received (St Jude Medical) for research, but there are no other competing interests.TRIAL REGISTRATION: Not relevant.
AB - INTRODUCTION: In atrial fibrillation (AF) patients with an increased stroke risk, oral anticoagulation (OAC) is the standard treatment for stroke prevention. However, this therapy carries a high risk of major bleeding. Percutaneous closure of the left atrial appendage (LAA) is suggested as an alternative option for stroke prevention in AF patients with contraindication(s) for OAC treatment.MATERIAL AND METHODS: A total of 42 patients underwent percutaneous LAA closure. In this report, we describe our experience with this procedure.RESULTS: The patients treated were AF patients with a high stroke risk (CHADS-VASc 4.5±1.4) and contra-indication(s) for OAC and/or a high bleeding risk (HAS-BLED 3.7±0.9). A history of intracerebral bleeding was the most common reason for LAA closure. Successful implantation was obtained in 41 of 42 patients. One major peri-procedural complication occurred; a major gastrointestinal bleeding immediately after the procedure. The mean duration of follow-up was 12.6 months. Both ischaemic stroke and bleeding occurred in one patient, resulting in an observed annual stroke and bleeding rate of 2.3%. This rate was lower than expected based on the CHADS-VASc (5.6%/year) and HAS-BLED (7.6%/year) for the patient cohort. At echo follow-up, incomplete LAA closure was seen in one case; device thrombosis was not observed.CONCLUSION: Our data confirm that percutaneous LAA closure can be a safe and effective strategy for stroke prevention in AF patients with an increased stroke and bleeding risk. However, long-term follow-up studies are needed before this procedure can be recommended for routine clinical use.FUNDING: Grant funding was received (St Jude Medical) for research, but there are no other competing interests.TRIAL REGISTRATION: Not relevant.
KW - Aged
KW - Aged, 80 and over
KW - Anticoagulants
KW - Atrial Appendage
KW - Atrial Fibrillation
KW - Female
KW - Humans
KW - Male
KW - Prosthesis Implantation
KW - Septal Occluder Device
KW - Stroke
M3 - Journal article
C2 - 25162439
VL - 61
SP - 1
EP - 4
JO - Danish Medical Journal
JF - Danish Medical Journal
SN - 2245-1919
IS - 8
M1 - A4879
ER -
ID: 137513305