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Novel nonpharmacologic approaches for stroke prevention in atrial fibrillation: results from clinical trials.

Proietti R, Joza J, Arensi A, Levi M, Russo V, Tzikas A, Danna P, Sagone A, Viecca M, Essebag V - Med Devices (Auckl) (2015)

Bottom Line: At this time, the most effective long-term solution to protect patients from stroke and thromboembolism is oral anticoagulation, either with vitamin K antagonists (VKAs) or a novel oral anticoagulant (NOAC).Despite the significant benefits they confer, both VKAs and NOACs are underused because of their increased potential for bleeding, and VKAs are underused because of their narrow therapeutic range, need for regular international normalized ratio checks, and interactions with food or medications.Percutaneous LAA closure, as an alternative to anticoagulation, has been increasingly used during the last decade in an effort to reduce stroke risk in nonvalvular AF.

View Article: PubMed Central - PubMed

Affiliation: McGill University Health Center, Montreal, QC, Canada ; Cardiology Department, Luigi Sacco Hospital, Milano, Italy.

ABSTRACT
Atrial fibrillation (AF), the most common cardiac arrhythmia, confers a 5-fold risk of stroke that increases to 17-fold when associated with mitral stenosis. At this time, the most effective long-term solution to protect patients from stroke and thromboembolism is oral anticoagulation, either with vitamin K antagonists (VKAs) or a novel oral anticoagulant (NOAC). Despite the significant benefits they confer, both VKAs and NOACs are underused because of their increased potential for bleeding, and VKAs are underused because of their narrow therapeutic range, need for regular international normalized ratio checks, and interactions with food or medications. In patients with nonvalvular AF, approximately 90% of strokes originate from the left atrial appendage (LAA); in patients with rheumatic mitral valve disease, many patients (60%) have strokes that originate from the left atrium itself. Surgical LAA amputation or closure, although widely used to reduce stroke risk in association with cardiac surgery, is not currently performed as a stand-alone operation for stroke risk reduction because of its invasiveness. Percutaneous LAA closure, as an alternative to anticoagulation, has been increasingly used during the last decade in an effort to reduce stroke risk in nonvalvular AF. Several devices have been introduced during this time, of which one has demonstrated noninferiority compared with warfarin in a randomized controlled trial. This review describes the available technologies for percutaneous LAA closure, as well as a summary of the published trials concerning their safety and efficacy in reducing stroke risk in AF.

No MeSH data available.


Related in: MedlinePlus

Amplatzer Amulet.Notes: Note the increased length of the distal lobe and the diameter of the proximal disc. Note the amulet has the screw inside while the ACP has a screw through it.
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f4-mder-8-103: Amplatzer Amulet.Notes: Note the increased length of the distal lobe and the diameter of the proximal disc. Note the amulet has the screw inside while the ACP has a screw through it.

Mentions: The newest Amplatzer Amulet (ACP-2) is the evolution of the original ACP device, a dedicated device for percutaneous LAA occlusion (Figure 4). The main design of the first generation ACP-1 is maintained, although several features were modified to improve feasibility of implantation procedure and orifice sealing: the stabilizing wires are stiffer and the number is increased from six to ten pairs, larger sizes are available (31 and 34 mm), the length of the distal lobe is increased by 2–3 mm, and the diameter of the proximal disc was increased by 5.5–8 mm. Freixa et al52 reported successful implantation in 24 of 25 patients with no periprocedural complications and no strokes at 3 months, suggesting feasibility and safety.


Novel nonpharmacologic approaches for stroke prevention in atrial fibrillation: results from clinical trials.

Proietti R, Joza J, Arensi A, Levi M, Russo V, Tzikas A, Danna P, Sagone A, Viecca M, Essebag V - Med Devices (Auckl) (2015)

Amplatzer Amulet.Notes: Note the increased length of the distal lobe and the diameter of the proximal disc. Note the amulet has the screw inside while the ACP has a screw through it.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4319717&req=5

f4-mder-8-103: Amplatzer Amulet.Notes: Note the increased length of the distal lobe and the diameter of the proximal disc. Note the amulet has the screw inside while the ACP has a screw through it.
Mentions: The newest Amplatzer Amulet (ACP-2) is the evolution of the original ACP device, a dedicated device for percutaneous LAA occlusion (Figure 4). The main design of the first generation ACP-1 is maintained, although several features were modified to improve feasibility of implantation procedure and orifice sealing: the stabilizing wires are stiffer and the number is increased from six to ten pairs, larger sizes are available (31 and 34 mm), the length of the distal lobe is increased by 2–3 mm, and the diameter of the proximal disc was increased by 5.5–8 mm. Freixa et al52 reported successful implantation in 24 of 25 patients with no periprocedural complications and no strokes at 3 months, suggesting feasibility and safety.

Bottom Line: At this time, the most effective long-term solution to protect patients from stroke and thromboembolism is oral anticoagulation, either with vitamin K antagonists (VKAs) or a novel oral anticoagulant (NOAC).Despite the significant benefits they confer, both VKAs and NOACs are underused because of their increased potential for bleeding, and VKAs are underused because of their narrow therapeutic range, need for regular international normalized ratio checks, and interactions with food or medications.Percutaneous LAA closure, as an alternative to anticoagulation, has been increasingly used during the last decade in an effort to reduce stroke risk in nonvalvular AF.

View Article: PubMed Central - PubMed

Affiliation: McGill University Health Center, Montreal, QC, Canada ; Cardiology Department, Luigi Sacco Hospital, Milano, Italy.

ABSTRACT
Atrial fibrillation (AF), the most common cardiac arrhythmia, confers a 5-fold risk of stroke that increases to 17-fold when associated with mitral stenosis. At this time, the most effective long-term solution to protect patients from stroke and thromboembolism is oral anticoagulation, either with vitamin K antagonists (VKAs) or a novel oral anticoagulant (NOAC). Despite the significant benefits they confer, both VKAs and NOACs are underused because of their increased potential for bleeding, and VKAs are underused because of their narrow therapeutic range, need for regular international normalized ratio checks, and interactions with food or medications. In patients with nonvalvular AF, approximately 90% of strokes originate from the left atrial appendage (LAA); in patients with rheumatic mitral valve disease, many patients (60%) have strokes that originate from the left atrium itself. Surgical LAA amputation or closure, although widely used to reduce stroke risk in association with cardiac surgery, is not currently performed as a stand-alone operation for stroke risk reduction because of its invasiveness. Percutaneous LAA closure, as an alternative to anticoagulation, has been increasingly used during the last decade in an effort to reduce stroke risk in nonvalvular AF. Several devices have been introduced during this time, of which one has demonstrated noninferiority compared with warfarin in a randomized controlled trial. This review describes the available technologies for percutaneous LAA closure, as well as a summary of the published trials concerning their safety and efficacy in reducing stroke risk in AF.

No MeSH data available.


Related in: MedlinePlus