Chava Raghuram, Turagam Mohit K, Lakkireddy Dhanunjaya Dj
Department of Internal Medicine, MedStar Harbor Hospital, Baltimore, MD, USA.
Section of Electrophysiology, Mount Sinai Hospital, New York, NY, USA.
J Innov Card Rhythm Manag. 2018 Apr 15;9(4):3095-3106. doi: 10.19102/icrm.2018.090402. eCollection 2018 Apr.
Left atrial appendage occlusion (LAAO) has emerged as an effective site-directed therapy in patients with nonvalvular atrial fibrillation (AF) for stroke prevention, who are ineligible for long-term oral anticoagulation. The objective of this study was to assess the safety, efficacy, and availability of LAAO devices by reviewing the literature and to review the development and effectiveness of LAAO by the transcatheter approach with plugging devices such as WATCHMAN™ (Boston Scientific, Natick, MA, USA); AMPLATZER™ Cardiac Plug and AMPLATZER™ Amulet™ (Abbott Laboratories, Chicago, IL, USA); and the LARIAT Suture Delivery Device (SentreHEART, Redwood City, CA, USA), which features an entirely unique hybrid (endocardial and epicardial) approach in closing the left atrial appendage (LAA). The conducted literature review ultimately revealed a substantial body of literature supporting the safety and efficacy of various LAAO strategies, including endocardial, epicardial, and hybrid approaches, in AF patients who are not eligible for long-term oral anticoagulant use. Specifically, the most attractive population suitable for LAA closure appears to be patients at high risk for ischemic stroke with a longer life expectancy but a moderate-to-high bleeding risk with long-term oral anticoagulation. The benefit of LAA closure in reducing the incidence of stroke in patients with nonvalvular AF has been evolving gradually, and we are confident that this new field of percutaneous LAA closure will continue to emerge as a game-changer in the treatment of AF.
左心耳封堵术（LAAO）已成为非瓣膜性心房颤动（AF）患者预防卒中的一种有效的局部定向治疗方法，这些患者不适合长期口服抗凝治疗。本研究的目的是通过回顾文献评估LAAO装置的安全性、有效性和可及性，并回顾采用诸如WATCHMAN™（美国波士顿科学公司，马萨诸塞州纳蒂克）、AMPLATZER™心脏封堵器和AMPLATZER™ Amulet™（美国雅培公司，伊利诺伊州芝加哥）以及LARIAT缝线输送装置（美国加利福尼亚州红木城SentreHEART公司）等封堵装置的经导管途径进行LAAO的发展情况和有效性，其中LARIAT缝线输送装置在关闭左心耳（LAA）方面采用了一种完全独特的混合（心内膜和心外膜）方法。所进行的文献综述最终揭示了大量支持各种LAAO策略（包括心内膜、心外膜和混合方法）在不适合长期口服抗凝治疗的AF患者中的安全性和有效性的文献。具体而言，最适合进行LAA关闭的人群似乎是预期寿命较长但长期口服抗凝治疗存在中度至高度出血风险的缺血性卒中高危患者。LAA关闭在降低非瓣膜性AF患者卒中发生率方面的益处一直在逐渐显现，我们相信经皮LAA关闭这一新领域将继续成为AF治疗中的一个变革因素。
