Early Experience Using a Left Atrial Appendage Occlusion Device in Patients with Atrial Fibrillation
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Purpose: Atrial fibrillation (AF) is one of the major risk factors for ischemic stroke, and 90% of thromboembolisms in these patients arise from the left atrial appendage (LAA). Recently, it has been documented that an LAA occlusion device (OD) is not inferior to warfarin therapy, and that it reduces mortality and risk of stroke in patients with AF. Materials and Methods: We implanted LAA-ODs in 5 Korean patients (all male, 59.8±7.3 years old) with long-standing persistent AF or permanent AF via a percutaneous trans-septal approach. Results: 1) The major reasons for LAA-OD implantation were high risk of recurrent stroke (80%), labile international neutralizing ratio with hemorrhage (60%), and 3/5 (60%) patients had a past history of failed cardioversion for rhythm control. 2) The mean LA size was 51.3±5.0 mm and LAA size was 25.1×30.1 mm. We implanted the LAA-OD (28.8±3.4 mm device) successfully in all 5 patients with no complications. 3) After eight weeks of anticoagulation, all patients switched from warfarin to anti-platelet agent after confirmation of successful LAA occlusion by trans-esophageal echocardiography. Conclusion: We report on our early experience with LAA-OD deployment in patients with 1) persistent or permanent AF who cannot tolerate anticoagulation despite significant risk of ischemic stroke, or 2) recurrent stroke in patients who are unable to maintain sinus rhythm.
Abstract
Purpose: Atrial fibrillation (AF) is one of the major risk factors for ischemic stroke, and 90% of thromboembolisms in these patients arise from the left atrial appendage (LAA). Recently, it has been documented that an LAA occlusion device (OD) is not inferior to warfarin therapy, and that it reduces mortality and risk of stroke in patients with AF. Materials and Methods: We implanted LAA-ODs in 5 Korean patients (all male, 59.8±7.3 years old) with long-standing persistent AF or permanent AF via a percutaneous trans-septal approach. Results: 1) The major reasons for LAA-OD implantation were high risk of recurrent stroke (80%), labile international neutralizing ratio with hemorrhage (60%), and 3/5 (60%) patients had a past history of failed cardioversion for rhythm control. 2) The mean LA size was 51.3±5.0 mm and LAA size was 25.1×30.1 mm. We implanted the LAA-OD (28.8±3.4 mm device) successfully in all 5 patients with no complications. 3) After eight weeks of anticoagulation, all patients switched from warfarin to anti-platelet agent after confirmation of successful LAA occlusion by trans-esophageal echocardiography. Conclusion: We report on our early experience with LAA-OD deployment in patients with 1) persistent or permanent AF who cannot tolerate anticoagulation despite significant risk of ischemic stroke, or 2) recurrent stroke in patients who are unable to maintain sinus rhythm.
참고문헌 (29)
- Kannel WB, "Epidemiologic features of chronic atrial fibrillation: the Framingham study", N Engl J Med, 306, pp.1018~1022 (1982)
- Go AS, "Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study", JAMA, 285, pp.2370~2375 (2001)
- Wolf PA, "Atrial fibrillation as an independent risk factor for stroke: the Framingham Study", Stroke, 22, pp.983~988 (1991)
- Benjamin EJ, "Impact of atrial fibrillation on the risk of death: the Framingham Heart Study", Circulation, 98, pp.946~952 (1998)
- Stoddard MF, "Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: a transesophageal echocardiographic study", J Am Coll Cardiol, 25, pp.452~459 (1995)
- Manning WJ, "Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study", Ann Intern Med, 123, pp.817~822 (1995)
- Leung DY, "Prognostic implications of left atrial spontaneous echo contrast in nonvalvular atrial fibrillation", J Am Coll Cardiol, 24, pp.755~762 (1994)
- Singer DE, "The net clinical benefit of warfarin anticoagulation in atrial fibrillation", Ann Intern Med, 151, pp.297~305 (2009)
- Corley SD, "Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study", Circulation, 109, pp.1509~1513 (2004)
- Petersen P, "Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study", Lancet, 1, pp.175~179 (1989)
- Hylek EM, "Translating the results of randomized trials into clinical practice: the challenge of warfarin candidacy among hospitalized elderly patients with atrial fibrillation", Stroke, 37, pp.1075~1080 (2006)
- Connolly SJ, "Dabigatran versus warfarin in patients with atrial fibrillation", N Engl J Med, 361, pp.1139~1151 (2009)
- Connolly S, "Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial", Lancet, 367, pp.1903~1912 (2006)
- Go AS, "Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study", Ann Intern Med, 131, pp.927~934 (1999)
- Camm AJ, "Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)", Europace, 12, pp.1360~1420 (2010)
- Bonow RO, "2008 Focused update incorporated into the ACC", AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology, Circulation, pp.2008, 118[DOI]
- Healey JS, "Left Atrial Appendage Occlusion Study (LAAOS): results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke", Am Heart J, 150, pp.288~293 (2005)
- Holmes DR, "Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial", Lancet, 374, pp.534~542 (2009)
- Hwang JJ, "Clinical implications and factors related to left atrial spontaneous echo contrast in chronic nonvalvular atrial fibrillation", Cardiology, 85, pp.69~75 (1994)
- Blackshear JL, "Thoracoscopic extracardiac obliteration of the left atrial appendage for stroke risk reduction in atrial fibrillation", J Am Coll Cardiol, 42, pp.1249~1252 (2003)
- Block PC, "Percutaneous left atrial appendage occlusion for patients in atrial fibrillation suboptimal for warfarin therapy: 5-year results of the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) Study", JACC Cardiovasc Interv, 2, pp.594~600 (2009)
- Singh SM, "Percutaneous left atrial appendage closure with an epicardial suture ligation approach: a prospective randomized pre-clinical feasibility study", Heart Rhythm, 7, pp.370~376 (2010)
- Reddy VY, "Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry", Circulation, 123, pp.417~424 (2011)
- Lip GY, "Atrial fibrillation and stroke prevention", Lancet Neurol, 6, pp.981~993 (2007)
- Hohnloser SH, "Effect of dronedarone on cardiovascular events in atrial fibrillation", N Engl J Med, 360, pp.668~678 (2009)
- Boyoung Joung, "The Role of the Calcium and the Voltage Clocks in Sinoatrial Node Dysfunction", Yonsei Medical Journal, 52(2), pp.211~219 (2011), 연세대학교의과대학
- 김원호, "Long-Term Outcome of Single-Chamber Atrial Pacing Compared with Dual-Chamber Pacing in Patients with Sinus-Node Dysfunction and Intact Atrioventricular Node Conduction", Yonsei Medical Journal, 51(6), pp.832~837 (2010), 연세대학교의과대학
- ROCKET AF Study Investigators, "Rivaroxaban-once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation: rationale and design of the ROCKET AF study", Am Heart J, 159, pp.340~347 (2010)
- Park JW, "Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation: initial European experience", Catheter Cardiovasc Interv, 77, pp.700~706 (2011)