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

被引:15
作者
Baman, Jayson R. [1 ,2 ]
Mansour, Moussa [3 ,4 ]
Heist, E. Kevin [3 ,4 ]
Huang, David T. [5 ]
Biton, Yitschak [2 ,3 ,4 ,5 ,6 ]
机构
[1] Northwestern Univ, Dept Med, Feinberg Sch Med, Chicago, IL 60611 USA
[2] Univ Rochester, Sch Med & Dent, Rochester, NY 14642 USA
[3] Massachusetts Gen Hosp, Boston, MA 02114 USA
[4] Harvard Med Sch, Boston, MA 02115 USA
[5] Univ Rochester, Dept Cardiol, Rochester, NY 14642 USA
[6] Massachusetts Gen Hosp, Cardiac Arrhythmia Serv, Boston, MA 02114 USA
关键词
Percutaneous; Left atrial appendage; Atrial fibrillation; Stroke; Watchman; LONG-TERM WARFARIN; WATCHMAN DEVICE; HEART-FAILURE; ORAL ANTICOAGULATION; COST-EFFECTIVENESS; ISCHEMIC-STROKE; CLOSURE; RISK; OUTCOMES; MULTICENTER;
D O I
10.1007/s10741-018-9681-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:191 / 208
页数:18
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