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Cardiology Research and Practice
Volume 2011, Article ID 752808, 7 pages
http://dx.doi.org/10.4061/2011/752808
Review Article

Left Atrial Appendage Closure in Atrial Fibrillation: A World without Anticoagulation?

1Department of Medicine, Michigan State University, B301 Clinical Center, East Lansing, MI 48824, USA
2Department of Rheumatologic and Immunologic Diseases, Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH 44195, USA

Received 20 December 2010; Accepted 1 February 2011

Academic Editor: Adrian Baranchuk

Copyright © 2011 Tahmeed Contractor and Atul Khasnis. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. A. S. Go, E. M. Hylek, K. A. Phillips et al., “Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study,” Journal of the American Medical Association, vol. 285, no. 18, pp. 2370–2375, 2001. View at Google Scholar · View at Scopus
  2. Y. Miyasaka, M. E. Barnes, B. J. Gersh et al., “Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence,” Circulation, vol. 114, no. 2, pp. 119–125, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  3. P. A. Wolf, R. D. Abbott, and W. B. Kannel, “Atrial fibrillation as an independent risk factor for stroke: the Framingham Study,” Stroke, vol. 22, no. 8, pp. 983–988, 1991. View at Google Scholar · View at Scopus
  4. P. A. Wolf, T. R. Dawber, H. E. Thomas, and W. B. Kannel, “Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study,” Neurology, vol. 28, no. 10, pp. 973–977, 1978. View at Google Scholar · View at Scopus
  5. R. G. Hart, L. A. Pearce, R. M. Rothbart, J. H. McAnulty, R. W. Asinger, and J. L. Halperin, “Stroke with intermittent atrial fibrillation: incidence and predictors during aspirin therapy,” Journal of the American College of Cardiology, vol. 35, no. 1, pp. 183–187, 2000. View at Publisher · View at Google Scholar
  6. R. G. Hart, “Warfarin in atrial fibrillation: underused in the elderly, often inappropriately used in the young,” Heart, vol. 82, no. 5, pp. 539–540, 1999. View at Google Scholar · View at Scopus
  7. S. H. Hohnloser, D. Pajitnev, J. Pogue et al., “Incidence of stroke in paroxysmal versus sustained atrial fibrillation in patients taking oral anticoagulation or combined antiplatelet therapy: an ACTIVE W Substudy,” Journal of the American College of Cardiology, vol. 50, no. 22, pp. 2156–2161, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  8. A. H. Tayal, M. Tian, K. M. Kelly et al., “Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke,” Neurology, vol. 71, no. 21, pp. 1696–1701, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  9. G. W. Petty, R. D. Brown Jr., J. P. Whisnant, J. D. Sicks, W. M. O'Fallon, and D. O. Wiebers, “Ischemic stroke subtypes: a population-based study of incidence and risk factors,” Stroke, vol. 30, no. 12, pp. 2513–2516, 1999. View at Google Scholar · View at Scopus
  10. N. Gaillard, S. Deltour, B. Vilotijevic et al., “Detection of paroxysmal atrial fibrillation with transtelephonic EKG in TIA or stroke patients,” Neurology, vol. 74, no. 21, pp. 1666–1670, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  11. M. J. G. Harrison and J. Marshall, “Atrial fibrillation, TIAs and completed strokes,” Stroke, vol. 15, no. 3, pp. 441–442, 1984. View at Google Scholar · View at Scopus
  12. D. C. Anderson, L. J. Kappelle, M. Eliasziw, V. L. Babikian, L. A. Pearce, and H. J. M. Barnett, “Occurrence of hemispheric and retinal ischemia in atrial fibrillation compared with carotid stenosis,” Stroke, vol. 33, no. 8, pp. 1963–1967, 2002. View at Publisher · View at Google Scholar · View at Scopus
  13. M. M. Kaarisalo, P. Immonen-Räihä, R. J. Marttila et al., “Atrial fibrillation and stroke: mortality and causes of death after the first acute ischemic stroke,” Stroke, vol. 28, no. 2, pp. 311–315, 1997. View at Google Scholar · View at Scopus
  14. J. Morley, R. Marinchak, S. J. Rials, and P. R. Kowey, “Atrial fibrillation, anticoagulation, and stroke,” American Journal of Cardiology, vol. 77, no. 3, pp. 38A–44A, 1996. View at Publisher · View at Google Scholar · View at Scopus
  15. R. G. Hart, L. A. Pearce, and M. I. Aguilar, “Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation,” Annals of Internal Medicine, vol. 146, no. 12, pp. 857–867, 2007. View at Google Scholar · View at Scopus
  16. A. L. Waldo, R. C. Becker, V. F. Tapson, and K. J. Colgan, “Hospitalized patients with atrial fibrillation and a high risk of stroke are not being provided with adequate anticoagulation,” Journal of the American College of Cardiology, vol. 46, no. 9, pp. 1729–1736, 2005. View at Publisher · View at Google Scholar · View at PubMed
  17. E. Birman-Deych, M. J. Radford, D. S. Nilasena, and B. F. Gage, “Use and effectiveness of warfarin in medicare beneficiaries with atrial fibrillation,” Stroke, vol. 37, no. 4, pp. 1070–1074, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  18. R. J. Beyth, M. R. Antani, K. E. Covinsky et al., “Why isn't warfarin prescribed to patients with nonrheumatic atrial fibrillation?” Journal of General Internal Medicine, vol. 11, no. 12, pp. 721–728, 1996. View at Google Scholar · View at Scopus
  19. B. F. Gage, M. Boechler, A. L. Doggette et al., “Adverse outcomes and predictors of underuse of antithrombotic therapy in medicare beneficiaries with chronic atrial fibrillation,” Stroke, vol. 31, no. 4, pp. 822–827, 2000. View at Google Scholar · View at Scopus
  20. D. K. Wysowski, P. Nourjah, and L. Swartz, “Bleeding complications with warfarin use: a prevalent adverse effect resulting in regulatory action,” Archives of Internal Medicine, vol. 167, no. 13, pp. 1414–1419, 2007. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  21. M. Kutner, G. Nixon, and F. Silverstone, “Physicians' attitudes toward oral anticoagulants and antiplatelet agents for stroke prevention in elderly patients with atrial fibrillation,” Archives of Internal Medicine, vol. 151, no. 10, pp. 1950–1953, 1991. View at Publisher · View at Google Scholar · View at Scopus
  22. J. A. O'Hare, N. Ul-Iman, and M. Geoghegan, “Non-anticoagulation in atrial fibrillation,” Irish Journal of Medical Science, vol. 163, no. 10, pp. 448–450, 1994. View at Google Scholar · View at Scopus
  23. N. L. Smith, B. M. Psaty, C. D. Furberg et al., “Temporal trends in the use of anticoagulants among older adults with atrial fibrillation,” Archives of Internal Medicine, vol. 159, no. 14, pp. 1574–1578, 1999. View at Publisher · View at Google Scholar · View at Scopus
  24. S. Haas, “New anticoagulants—towards the development of an "ideal" anticoagulant,” Vasa, vol. 38, no. 1, pp. 13–29, 2009. View at Google Scholar · View at Scopus
  25. S. J. Connolly, M. D. Ezekowitz, S. Yusuf et al., “Dabigatran versus warfarin in patients with atrial fibrillation,” New England Journal of Medicine, vol. 361, no. 12, pp. 1139–1151, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  26. I. Ehrens, G. Y. H. Lip, and K. Peters, “What do the RE-LY, AVERROES and ROCKET-AF trials tell us for stroke prevention in atrial fibrillation?” Thrombosis and Haemostasis, vol. 105, no. 4, 2011. View at Google Scholar
  27. N. M. Al-Saady, O. A. Obel, and A. J. Camm, “Left atrial appendage: structure, function, and role in thromboembolism,” Heart, vol. 82, no. 5, pp. 547–554, 1999. View at Google Scholar · View at Scopus
  28. T. W. Sadler, “Cardiovascular system,” in Langman’s Medical Embryology, J. Langman, Ed., pp. 179–227, Williams and Wilkins, Baltimore, Md, USA, 6th edition, 1990. View at Google Scholar
  29. G. Ernst, C. Stöllberger, F. Abzieher et al., “Morphology of the left atrial appendage,” Anatomical Record, vol. 242, no. 4, pp. 553–561, 1995. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  30. M. A. García-Fernandez, E. G. Torrecilla, D. S. Román et al., “Left atrial appendage Doppler flow patterns: implications on thrombus formation,” American Heart Journal, vol. 124, no. 4, pp. 955–961, 1992. View at Publisher · View at Google Scholar · View at Scopus
  31. J. L. Blackshear and J. A. Odell, “Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation,” Annals of Thoracic Surgery, vol. 61, no. 2, pp. 755–759, 1996. View at Publisher · View at Google Scholar · View at Scopus
  32. R. P. Whitlock, J. S. Healey, and S. J. Connolly, “Left atrial appendage occlusion does not eliminate the need for warfarin,” Circulation, vol. 120, no. 19, pp. 1927–1932, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  33. J. S. Healey, E. Crystal, A. Lamy et al., “Left Atrial Appendage Occlusion Study (LAAOS): results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke,” American Heart Journal, vol. 150, no. 2, pp. 288–293, 2005. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  34. M. A. García-Fernández, E. Pérez-David, J. Quiles et al., “Role of left atrial appendage obliteration in stroke reduction in patients with mitral valve prosthesis: a transesophageal echocardiographic study,” Journal of the American College of Cardiology, vol. 42, no. 7, pp. 1253–1258, 2003. View at Publisher · View at Google Scholar · View at Scopus
  35. E. S. Katz, T. Tsiamtsiouris, R. M. Applebaum, A. Schwartzbard, P. A. Tunick, and I. Kronzon, “Surgical left atrial appendage ligation is frequently incomplete: a transesophageal echocardiographic study,” Journal of the American College of Cardiology, vol. 36, no. 2, pp. 468–471, 2000. View at Publisher · View at Google Scholar · View at Scopus
  36. B. Meier, I. Palacios, S. Windecker et al., “Transcatheter left atrial appendage occlusion with Amplatzer devices to obviate anticoagulation in patients with atrial fibrillation,” Catheterization and Cardiovascular Interventions, vol. 60, no. 3, pp. 417–422, 2003. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  37. H. Sievert, M. D. Lesh, T. Trepels et al., “Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience,” Circulation, vol. 105, no. 16, pp. 1887–1889, 2002. View at Publisher · View at Google Scholar
  38. S. H. Ostermayer, M. Reisman, P. H. Kramer et al., “Percutaneous left atrial appendage transcatheter occlusion (PLAATO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: results from the international multi-center feasibility trials,” Journal of the American College of Cardiology, vol. 46, no. 1, pp. 9–14, 2005. View at Publisher · View at Google Scholar · View at PubMed
  39. P. C. Block, S. Burstein, P. N. Casale et al., “Percutaneous left atrial appendage occlusion for patients in atrial fibrillation suboptimal for warfarin therapy: 5-year results of the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) Study,” JACC Cardiovascular Interventions, vol. 2, no. 7, pp. 594–600, 2009. View at Publisher · View at Google Scholar · View at PubMed
  40. P. B. Sick, G. Schuler, K. E. Hauptmann et al., “Initial worldwide experience with the WATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation,” Journal of the American College of Cardiology, vol. 49, no. 13, pp. 1490–1495, 2007. View at Publisher · View at Google Scholar · View at PubMed
  41. R. B. Fountain, D. R. Holmes, K. Chandrasekaran et al., “The PROTECT AF (WATCHMAN left atrial appendage system for embolic PROTECTion in patients with atrial fibrillation) trial,” American Heart Journal, vol. 151, no. 5, pp. 956–961, 2006. View at Publisher · View at Google Scholar · View at PubMed
  42. R. Virmani, F. D. Kolodgie, M. D. Dake et al., “Histopathologic evaluation of an expanded polytetrafluoroethylene- nitinol stent endoprosthesis in canine iliofemoral arteries,” Journal of Vascular and Interventional Radiology, vol. 10, no. 4, pp. 445–456, 1999. View at Google Scholar
  43. T. Nakai, E. P. Gerstenfeld, C. Stillson et al., “Intracardiac echocardiography guided implantation of a novel left atrial appendage occlusion device for preventing thrombembolism,” Pacing and Cardiac Electrophysiology, vol. 24, p. 639, 2001. View at Google Scholar
  44. S. Rietbrock, E. Heeley, J. Plumb, and T. van Staa, “Chronic atrial fibrillation: incidence, prevalence, and prediction of stroke using the Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack (CHADS2) risk stratification scheme,” American Heart Journal, vol. 156, no. 1, pp. 57–64, 2008. View at Publisher · View at Google Scholar · View at PubMed
  45. D. R. Holmes, V. Y. Reddy, Z. G. Turi 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,” The Lancet, vol. 374, no. 9689, pp. 534–542, 2009. View at Publisher · View at Google Scholar · View at Scopus
  46. C. Van Walraven, R. G. Hart, D. E. Singer et al., “Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: an individual patient meta-analysis,” Journal of the American Medical Association, vol. 288, no. 19, pp. 2441–2448, 2002. View at Publisher · View at Google Scholar · View at Scopus
  47. S. Kaul, E. Cingolani, M. Shehata, and G. A. Diamond, “How does left atrial appendage occlusion using the Watchaman device compare to dabibatran for reducing thromboembolic eventis in patients with nonvalvular atrial fibrillation,” Journal of the American College of Cardiology, vol. 55, no. 10A, p. A4E39, 2010. View at Google Scholar