Frazzetto Marco, Sanfilippo Claudio, Costa Giuliano, Contrafatto Claudia, Giacalone Chiara, Scandura Salvatore, Castania Giuseppe, De Santis Jessica, Sanfilippo Maria, Di Salvo Maria Elena, Tamburino Corrado, Barbanti Marco, Grasso Carmelo
Division of Cardiology, A.O.U. Policlinico "G. Rodolico San Marco", 95123 Catania, Italy.
Faculty of Medicine and Surgery, Università degli Studi di Enna "Kore", 94100 Enna, Italy.
J Clin Med. 2024 Aug 8;13(16):4651. doi: 10.3390/jcm13164651.
Left atrial appendage closure (LAAC) is a crucial intervention for stroke prevention in patients with non-valvular atrial fibrillation who are unsuitable for long-term anticoagulation. Amulet and Watchman are the most implanted devices worldwide for performing LAAC, and the aim of this review is to provide a comprehensive comparison focusing on their efficacy, safety, and short- and long-term outcomes. The Watchman device, the first to gain FDA approval, has been extensively studied and demonstrates significant reductions in stroke and systemic embolism rates. The Amulet device, a newer alternative, promises enhanced design features for more efficient appendage sealing. Current data highlight that both devices offer similar efficacy and safety for LAAC. While the two devices differ in terms of intraprocedural complication rates, they offer similar short- to long-term outcomes in terms of peri-device leaks, device-related thrombosis, and mortality. Both devices are indicated for patients who are unable to tolerate OAC, given their similar risk and safety profiles. Newer clinical studies are directed at establishing the efficacy of both devices as the primary method for stroke prevention in AF as an alternative to OAC.
左心耳封堵术（LAAC）是对不适合长期抗凝治疗的非瓣膜性心房颤动患者进行卒中预防的关键干预措施。Amulet和Watchman是全球植入最多的用于实施LAAC的装置，本综述的目的是对它们的疗效、安全性以及短期和长期结果进行全面比较。Watchman装置是首个获得美国食品药品监督管理局（FDA）批准的装置，已得到广泛研究，并显示出卒中及系统性栓塞发生率显著降低。Amulet装置作为一种较新的替代产品，其设计特点有望得到改进，从而实现更有效的心耳封堵。目前的数据表明，这两种装置在LAAC方面具有相似的疗效和安全性。虽然这两种装置在术中并发症发生率方面存在差异，但在装置周围渗漏、与装置相关的血栓形成及死亡率方面，它们的短期至长期结果相似。鉴于它们具有相似的风险和安全性，这两种装置均适用于无法耐受口服抗凝药（OAC）的患者。新的临床研究旨在确定这两种装置作为房颤卒中预防的主要方法替代OAC的疗效。
