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Percutaneous closure of the left atrial appendage for secondary prevention of stroke in patients with atrial fibrillation and contraindications to chronic anticoagulant therapy.

Lasek-Bal A, Mizia-Stec K - Postepy Kardiol Interwencyjnej (2015)

Bottom Line: Transoesophageal echocardiography was carried out in the qualification period, 1-3 days before the intervention, and at 1-3 days and 3 and 6 months following the procedure.No complications were observed in the perioperative period and during the follow-up period of 16-31 months.Echocardiographic examinations showed that occluders were present in the appropriate positions.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Medical University of Silesia, Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland.

ABSTRACT

Introduction: Stroke accounts for approx. 90% of thromboembolic complications associated with atrial fibrillation. The use of oral anticoagulants is the most effective therapy but is associated with risk of haemorrhagic complications.

Aim: In this article, we describe a series of patients with atrial fibrillation, cardiogenic stroke history, and contraindications for long-term anticoagulant therapy, in whom an alternative method - percutaneous closure of the left atrial appendage - was performed.

Material and methods: Nine patients with atrial fibrillation and previous stroke were qualified for percutaneous closure of the left atrial appendage (5 men and 4 women, aged 45-78 years). Physical and neurological examinations were conducted in the qualification period, 1-3 days before the intervention, and 1-3 days and 1, 3, 6, 12, and 24 months following percutaneous closure of the left atrial appendage. Transoesophageal echocardiography was carried out in the qualification period, 1-3 days before the intervention, and at 1-3 days and 3 and 6 months following the procedure.

Results: No complications were observed in the perioperative period and during the follow-up period of 16-31 months. Echocardiographic examinations showed that occluders were present in the appropriate positions.

Conclusions: Percutaneous closure of the left atrial appendage can be an alternative form of secondary prevention of stroke in patients with atrial fibrillation and contraindications for long-term anticoagulant therapy or those who have problems managing drug treatment. Complex clinical assessment performed by a neuro-cardiac team allows safe and efficient invasive treatment.

No MeSH data available.


Related in: MedlinePlus

Flow chart for selection of patients for LAA closure
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Figure 0001: Flow chart for selection of patients for LAA closure

Mentions: Between January 2011 and April 2013, in 307 patients (of the 371 with suffered from cardiogenic stroke), warfarin or new oral anticoagulants (NOACs) were used in secondary prevention (Figure 1). In 53 individuals antiplatelet therapy was introduced due to the inability to use oral anticoagulation (difficulties in the monitoring of coagulation parameters and maintenance international normalised ratio (INR) in the therapeutic range, bleeding during anticoagulant therapy). Eleven patients, aged 45–79 years, 7 men and 4 women, were qualified for percutaneous closure of the LAA. The main inclusion criteria were as follows: the presence of atrial fibrillation, a past history of clinically apparent cardiogenic stroke (which had occurred > 2 months earlier), ineffectiveness of long-term oral OAT, its limitation, or contraindications for its use. The main exclusion criteria were as follows: the presence of thrombus in the LAA detected on transoesophageal echocardiography (TEE), left ventricular wall motion abnormalities, the anatomical structure of the LAA hindering occluder implantation, stroke of aetiology other than that associated with AF, and allergy to ionic contrast media. Physical and neurological examinations were conducted in the qualification period, 1–3 days before the intervention, and 1–3 days, 1, 3, 6, 12, and 24 months following percutaneous closure of the LAA. Transoesophageal echocardiography was carried out in the qualification period, 1–3 days before the intervention as well as at 1–3 days and 3 and 6 months following the procedure.


Percutaneous closure of the left atrial appendage for secondary prevention of stroke in patients with atrial fibrillation and contraindications to chronic anticoagulant therapy.

Lasek-Bal A, Mizia-Stec K - Postepy Kardiol Interwencyjnej (2015)

Flow chart for selection of patients for LAA closure
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372626&req=5

Figure 0001: Flow chart for selection of patients for LAA closure
Mentions: Between January 2011 and April 2013, in 307 patients (of the 371 with suffered from cardiogenic stroke), warfarin or new oral anticoagulants (NOACs) were used in secondary prevention (Figure 1). In 53 individuals antiplatelet therapy was introduced due to the inability to use oral anticoagulation (difficulties in the monitoring of coagulation parameters and maintenance international normalised ratio (INR) in the therapeutic range, bleeding during anticoagulant therapy). Eleven patients, aged 45–79 years, 7 men and 4 women, were qualified for percutaneous closure of the LAA. The main inclusion criteria were as follows: the presence of atrial fibrillation, a past history of clinically apparent cardiogenic stroke (which had occurred > 2 months earlier), ineffectiveness of long-term oral OAT, its limitation, or contraindications for its use. The main exclusion criteria were as follows: the presence of thrombus in the LAA detected on transoesophageal echocardiography (TEE), left ventricular wall motion abnormalities, the anatomical structure of the LAA hindering occluder implantation, stroke of aetiology other than that associated with AF, and allergy to ionic contrast media. Physical and neurological examinations were conducted in the qualification period, 1–3 days before the intervention, and 1–3 days, 1, 3, 6, 12, and 24 months following percutaneous closure of the LAA. Transoesophageal echocardiography was carried out in the qualification period, 1–3 days before the intervention as well as at 1–3 days and 3 and 6 months following the procedure.

Bottom Line: Transoesophageal echocardiography was carried out in the qualification period, 1-3 days before the intervention, and at 1-3 days and 3 and 6 months following the procedure.No complications were observed in the perioperative period and during the follow-up period of 16-31 months.Echocardiographic examinations showed that occluders were present in the appropriate positions.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Medical University of Silesia, Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland.

ABSTRACT

Introduction: Stroke accounts for approx. 90% of thromboembolic complications associated with atrial fibrillation. The use of oral anticoagulants is the most effective therapy but is associated with risk of haemorrhagic complications.

Aim: In this article, we describe a series of patients with atrial fibrillation, cardiogenic stroke history, and contraindications for long-term anticoagulant therapy, in whom an alternative method - percutaneous closure of the left atrial appendage - was performed.

Material and methods: Nine patients with atrial fibrillation and previous stroke were qualified for percutaneous closure of the left atrial appendage (5 men and 4 women, aged 45-78 years). Physical and neurological examinations were conducted in the qualification period, 1-3 days before the intervention, and 1-3 days and 1, 3, 6, 12, and 24 months following percutaneous closure of the left atrial appendage. Transoesophageal echocardiography was carried out in the qualification period, 1-3 days before the intervention, and at 1-3 days and 3 and 6 months following the procedure.

Results: No complications were observed in the perioperative period and during the follow-up period of 16-31 months. Echocardiographic examinations showed that occluders were present in the appropriate positions.

Conclusions: Percutaneous closure of the left atrial appendage can be an alternative form of secondary prevention of stroke in patients with atrial fibrillation and contraindications for long-term anticoagulant therapy or those who have problems managing drug treatment. Complex clinical assessment performed by a neuro-cardiac team allows safe and efficient invasive treatment.

No MeSH data available.


Related in: MedlinePlus