Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
J Cardiol. 2022 Feb;79(2):186-193. doi: 10.1016/j.jjcc.2021.08.031. Epub 2021 Sep 24.
Atrial fibrillation (AF) is responsible for cardiogenic stroke. Since left atrial appendage (LAA) is a cause of most of cardiac thrombus, LAA closure is an emerging novel stroke prevention procedure for patients with AF alternative to anticoagulation. WATCHMAN LAA Closure device (Boston Scientific, Marlborough, MA, USA) is the only approved device in the USA and Japan. The device is indicated in high bleeding risk and high stroke risk non-valvular AF patients. Cardiac tamponade, stroke, and device embolization are typical procedural complications. Procedural complication rate is reduced with implanters' experience and matured procedure steps. Several randomized trials demonstrated procedure safety and efficacy of the device. The device resulted in similar thromboembolic event rates but significantly reduced bleeding events compared to anticoagulants. After the procedure, optimal post procedural antithrombotic drug regimen has not been fully investigated. Also, device-related thrombosis can be a new issue. Modification of the device can improve issues, but not fully solve it. Tailor made treatment based on the individual risk by heart team communication with neurologists is essential to treat patients.
心房颤动（AF）可导致心源性卒中。由于左心耳（LAA）是大多数心源性血栓的成因，因此对于 AF 患者，LAA 封堵术作为一种新兴的、替代抗凝的卒中预防方法，已逐渐普及。Watchman LAA 封堵装置（波士顿科学公司，马萨诸塞州马尔伯勒，美国）是唯一在美国和日本获得批准的装置。该装置适用于高出血风险和高卒中风险的非瓣膜性 AF 患者。心脏压塞、卒中和装置栓塞是典型的手术并发症。随着术者经验的积累和手术步骤的成熟，手术并发症发生率降低。几项随机试验证明了该装置的安全性和有效性。与抗凝剂相比，该装置可导致相似的血栓栓塞事件发生率，但显著降低了出血事件发生率。手术后，尚未充分研究最佳的术后抗血栓药物方案。此外，装置相关血栓可能是一个新问题。装置改良可以改善相关问题，但并不能完全解决。通过心脏团队与神经科医生的沟通，根据个体风险制定个体化治疗方案，对于治疗患者至关重要。
