Left Atrial Appendage Closure Mechanical Approaches to Stroke Prevention in Atrial Fibrillation 1st Edition by Humana Press ISBN 3319162802 9783319162805

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ISBN 10: 3319162802 
ISBN 13: 9783319162805
Author: Humana Press

Percutaneous left atrial appendage (LAA) closure is an emerging technology for thromboembolic prevention in patients with atrial fibrillation (AF). The first human implantation of an LAA device occurred in 2001, and since then four devices have received CE mark approval. These devices are being widely used in Europe for LAA closure in patients who are poor candidates for long-term oral anticoagulation. In the US, the WATCHMAN device (Boston Scientific) is anticipated to receive FDA approval imminently for AF patients who are warfarin-eligible. This approval is projected to significantly expand the indications for LAA closures worldwide. Thus, the volume of procedures is anticipated to escalate. This book discusses the epidemiology of AF as a cause of stroke; the use of LAA closure in the reduction of thromboembolism with AF; early surgical approaches and novel surgical devices for LAA closure; and current percutaneous approaches and devices available for LAA closure. The emphasis of this book is on percutaneous technical approaches and contemporary trial results on the leading devices (PLAATO, WATCHMAN, Amplatzer Cardiac Plug, and LARIAT). It also reviews unapproved devices in development, in both clinical and pre-clinical phases.

Left Atrial Appendage Closure Mechanical Approaches to Stroke Prevention in Atrial Fibrillation 1st Table of contents:

Part I: Rationale for LAA Closure
Chapter 1: Atrial Fibrillation and Stroke Epidemiology
Atrial Fibrillation Prevalence, Incidence and Global Burden
Atrial Fibrillation Incidence and Prevalence
Rising Prevalence and Global Burden of AF
Atrial Fibrillation and the Risk of Stroke
Rheumatic Valvular Heart Disease and the Risk of Stroke
Nonvalvular Atrial Fibrillation and the Risk of Stroke
Clinical Risk Stratification for Stroke Prediction
CHADS2 Index
CHA2DS2-VASc Score
HAS-BLED Bleeding Risk Score
Severity of AF-Related Stroke
The Economic Cost of AF-Related Stroke
The Impact of Thromboprophylaxis
Economic Modelling and the Burgeoning AF Burden
Conclusion
References
Chapter 2: Efficacy and Limitations of Warfarin and Novel Oral Anticoagulants with Atrial Fibril
Introduction
Warfarin for the Prevention of Stroke and Systemic Embolism
Vitamin K Antagonist Pharmacology and Therapeutic Challenges
The Development and Clinical Evaluation of the New Oral Anticoagulants
Choosing Between a VKA and a NOAC
Patient and Physician Convenience
Efficacy and Safety (Table 2.3)
Additional Considerations Influencing the Choice of Warfarin vs. a NOAC
Choosing Among the NOACs
Efficacy, Safety and Other Features of Individual NOACs vs. Warfarin in the RCTs
Conclusions
References
Chapter 3: Mechanistic Rationale for LAA Closure with AF and Stroke Prevention
Introduction
Anatomy and Physiology
Variable Pathology
Approaches to Stroke Prevention in AF
Conclusion
References
Chapter 4: LAA Anatomy
Introduction
Overall Anatomy of the LAA
Left Atrial Structures and the LAA
Atrial Septum and LAA
LAA Ostium
LAA Neck
Lobar Region
Conclusions
References
Part II: Surgical Approaches for LAA Closure
Chapter 5: Conventional Surgery for LAA Closure
Introduction
The Left Atrial Appendage
Excluding the Left Atrial Appendage from Systemic Circulation
Atrial Fibrillation Surgery
Cox Maze
Surgical Techniques for Left Atrial Appendage Occlusion
Simple Neck Ligation
Purse-String Technique
Endocardial Suturing
Envagination and Double Suture Technique
Surgical Amputation and Closure (Cut and Sew)
Surgical Stapler
Novel Techniques for LAA Occlusion
Atriclip
TigerPaw
Endoloop Snare
LigaSure TM Vessel Sealing System
Complications of LAA Occlusion Surgery
Evidence Regarding Safety and Efficacy of Left Atrial Appendage Occlusion
Animal Studies
Human Studies
Ongoing Trials
Existing Guidelines
Conclusion
References
Part III: Imaging for LAA Closure
Chapter 6: The Use of Transesophageal Echocardiography to Guide Percutaneous LAA Closure
LAA 3D Spatial Anatomical Imaging
What About 3D Imaging of the LAA?
The “Landing Zone”
Trans-Septal Puncture
If There Is a Patent Foramen Ovale, Can I Use This to Cross the Septum?
TEE Imaging of Instrumentation of the LAA
TEE Imaging Planes and Cine Imaging Correlation
Assessment of Device Position and Stability
Final TEE Assessment After Device Release
Conclusion
Chapter 7: The Use of Intracardiac Echocardiography (ICE) to Guide LAA Closure
Introduction
Technology Background
Step-by-Step Ice Image Orientation for LAA Closure
Inserting the Catheter (Liver View)
Start View
Aorta and Pulmonary Artery
Inter-Atrial Septum and Fossa Ovalis View
How to Perform an ICE-Guided Transseptal Puncture
LAA View
Coronary Sinus (CS) View
Para-coronary Sinus View (LAA)
LAA View from Pulmonary Artery
LAA View from the LA and Left Superior Pulmonary Vein (LSPV)
3D ICE
Complications: Recognition and Monitoring
The Cost–Benefit Ratio
Conclusion
References
Chapter 8: CT Imaging for Percutaneous LAA Closure
Introduction
LAA Anatomy
Baseline CCTA to Rule out LAA Thrombus
Baseline CCTA Protocol for LAA Closure Preplanning
Digital Post-processing Assessment of LAA
Assessment of LAA on CCTA for Endovascular Device Closure
Pre-procedural CCTA for LARIAT Procedure
Post-Surveillance with CCTA After LAA Closure
Conclusions
References
Part IV: Percutaneous LAA Closure Devices and Trial Results
Chapter 9: PLAATO Device
Introduction
PLAATO Device
Preclinical Studies
Clinical Results
Postmortem Analysis of the PLAATO Device
Conclusion
References
Chapter 10: WATCHMAN Device
Historical Background
WATCHMAN Clinical Trials and Evidence Base
PROTECT AF
CAP Registry
PREVAIL Study
ASAP Study
Implant Success Rates
WATCHMAN Device Characteristics
Device
Delivery Catheter
WATCHMAN Access Sheath
Next-Generation ‘WATCHMAN FLX’ Device
Procedural Technique
Pre-procedural Planning
Device Sizing
Vascular Access and Transseptal Catheterisation
WATCHMAN Access Sheath Positioning
Introducing the WATCHMAN Delivery Catheter
WATCHMAN Device Deployment
Repositioning the WATCHMAN Device
WATCHMAN Device Release
Periprocedural Patient Care
Patient Follow-up
Procedural Complications
Procedure-Related Stroke
Pericardial Effusions
Device Embolization
Device-Associated Thrombus
Clinical Significance of Peri-Device Leaks
Conclusions
References
Chapter 11: WATCHMAN: Trials and Registries Results
Introduction
WATCHMAN Regulatory Approvals
WATCHMAN Clinical Trial Program
Pilot Feasibility Study
PROTECT AF Study
CAP Registry
PREVAIL Study
Meta-Analysis of PROTECT AF and PREVAIL
ASAP Study
Ongoing Registries
Future Directions
Conclusions
References
Chapter 12: Amplatzer Cardiac Plug and Amulet
Introduction
Amplatzer Cardiac Plug and Amulet Device Characteristics
Implantation Technique
Preprocedural Imaging
Procedural Imaging
Transseptal Puncture
Fluoroscopic LAA Measurements
Access Sheath Advancement
ACP/Amulet Sizing and Implantation Steps
Procedural and Late Complications
Conclusions
References
Chapter 13: ACP and Amulet: Trials and Registries Results
Introduction
Summary of Technical Features: Amplatzer Cardiac Plug Versus Amplatzer Amulet
Amplatzer Cardiac Plug Registries and Trials
Procedural and In-Hospital Outcomes
Long-Term Follow-up
Amplatzer Amulet Data
Conclusions
References
Chapter 14: LARIAT: The Endo-Epicardial Technique for Left Atrial Appendage Exclusion
Introduction
The LARIAT Device
Indications and Contraindications for LARIAT Procedure
Indications
Contraindications
Preoperative Assessment
LARIAT Procedure
Epicardial Access
Transseptal Access
Anticoagulation Management
Follow-Up
Complications
Perioperative Complications
Late Complications
Efficacy of LARIAT Procedure
Management of Post-LARIAT Leaks
Role of LARIAT in Rhythm Management
Role of LARIAT in Homeostasis
Conclusion
References
Chapter 15: LARIAT: Trials and Registries Results
First-in-Man Experience
Initial Outcomes Data
US Single-Center Experiences
Multi-Center Registries
Other Reported Data
LAA Stump Thrombus
Leakage Occlusion
FDA Maude Database
Future Studies
Conclusions
References
Chapter 16: Novel Percutaneous LAA Closure Devices in Clinical or Preclinical Trials
Introduction
Coherex
Occlutech LAA Occluder
Lifetech LAmbre LAA Closure System
Cardia Ultrasept Closure Device
Conclusion
References
Chapter 17: Concomitant Left Atrial Appendage Closure and Catheter Ablation of Atrial Fibrillation
Introduction
Rationale for a Combined Procedure
Patient Selection
Ablation Procedure
Cryoenergy
Radiofrequency Current
LAA Closure
Post-procedural Management
Results of Our Experience with Combined AF Ablation and LAA Closure
Patient Population Characteristics (Table 17.1)
Procedural Parameters (Table 17.2)
Cryoballoon Pulmonary Vein Isolation
LAA Occlusion
Follow-up (Table 17.3)
Arrhythmia Recurrence
LAA Mechanical Closure
Procedural Outcome
Previous Studies
Conclusion
References
Part V: Post-procedural Management and Issues
Chapter 18: Procedural Complications and Management
Introduction
Pericardial Effusion/Perforation
Device Embolization
Stroke
Miscellaneous Complications
Conclusion
References
Chapter 19: Antiplatelet and Anticoagulant Strategies Following Left Atrial Appendage Closure
LAAO Device-Related Thrombus
LAAO Device Implantation Without Anticoagulation
Thromboembolic Risk from Residual Peri-Device Flow
Use of Novel Oral Anticoagulants
No Long-Term Therapy
Summary
References
Chapter 20: Device-Related Thrombi, Residual Leaks, and Consequences
Introduction
Current Data
Surgical LAA Ligation
Percutaneous LAA Closure
Definition and Diagnosis of Device-Related Thrombi Formation and Residual Leaks
Device-Related Thrombi
Residual Leaks
Etiology and Causes of Device-Related Thrombi Formation and Residual Leaks
Different Devices

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