Mechanistic Rationale for LAA Closure with AF and Stroke Prevention

Feasibility and safety of left atrial appendage closure in a patient with previous foramen ovale occlusion: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab113 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Mario Matta ◽

Ludovica Maltese ◽

Fabrizio Ugo ◽

Maria Virginia Di Ruocco ◽

Francesco Rametta

Keyword(s):

Stroke Prevention ◽

Left Atrial ◽

Left Atrial Appendage ◽

Multimodality Imaging ◽

Atrial Appendage ◽

Foramen Ovale ◽

Occlusion Device ◽

Increased Risk ◽

Cardiac Model ◽

Laa Closure

Abstract Background Left atrial appendage (LAA) closure is an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation (AF) at high bleeding risk. Patients with a previous percutaneous closure of a patent foramen ovale (PFO) present an increased risk for developing AF during their life, and the presence of an atrial septal device renders future percutaneous left atrial access more challenging. Very few cases of LAA occlusion in patients with a preexisting PFO closure device have been previously reported. Case summary A 74-years old woman was admitted to our hospital for symptomatic severe anaemia during direct oral anticoagulant treatment. Her past medical history reported an ischaemic stroke at the age of 55, at that time a PFO was diagnosed and a STARFlex™ PFO occluder (NMT Medical, Boston, MA, USA) was implanted. During the current hospitalization, the patient underwent a colonoscopy that showed colonic angiodysplasias unsuitable for endoscopic treatment and LAA closure was indicated for stroke prevention. After a multimodality pre-procedural planning that included a transoesophageal echocardiogram, a cardiac computed tomography scan and a three-dimensional cardiac model printing, the procedure was planned and the LAA successfully occluded. Discussion LAA closure can be performed safely and effectively in patients carrying a previously implanted PFO occlusion device. In complex settings, a pre-procedural multimodality imaging is critical for improving the procedural safety and success rate. We describe the first case of percutaneous LAA closure in a patient with a prior PFO occlusion with the implantation of a STARflex™ septal occlusion device.

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European registry data on LAA closure: advancing the field of interventional stroke prevention

EuroIntervention ◽

10.4244/eijv14i2a20 ◽

2018 ◽

Vol 14 (2) ◽

pp. 135-138

Author(s):

Martin W. Bergmann

Keyword(s):

Stroke Prevention ◽

Registry Data ◽

European Registry ◽

Laa Closure

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22-05: Combining LAA closure and catheter ablation for long-term stroke prevention: multicenter registry results of feasibility, efficacy, and safety during implant and 30 days follow-up

EP Europace ◽

10.1093/europace/18.suppl_1.i26b ◽

2016 ◽

Vol 18 (suppl_1) ◽

pp. i26-i26

Author(s):

Lucas V Boersma ◽

Evgeny Pokushalov ◽

Alexander Romanov ◽

Sergey Artemenko ◽

Richard Folkeringa ◽

...

Keyword(s):

Catheter Ablation ◽

Stroke Prevention ◽

Efficacy And Safety ◽

Multicenter Registry ◽

Laa Closure

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Percutaneous left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation

Future Neurology ◽

10.2217/fnl-2020-0001 ◽

2020 ◽

Vol 15 (3) ◽

pp. FNL48

Author(s):

Hans-Christoph Diener ◽

Ulf Landmesser

Keyword(s):

Atrial Fibrillation ◽

High Risk ◽

Stroke Prevention ◽

Left Atrial ◽

Left Atrial Appendage ◽

Oral Anticoagulants ◽

Atrial Appendage ◽

Bleeding Complications ◽

Randomized Studies ◽

Laa Closure

Patients with atrial fibrillation (AF) have a fivefold higher risk of stroke than persons in sinus rhythm. Effective stroke prevention is achieved with oral anticoagulants such as vitamin K antagonists or nonvitamin K oral anticoagulants. An alternative for stroke prevention in patients with AF is the closure of the left atrial appendage (LAA) with a percutaneously applied closure system. The two large randomized studies PROTECT-AF and PREVAIL failed to show superiority of LAA closure over anticoagulation in patients with AF. Meta-analyses of studies and registries, however, suggest that LAA closure has particular advantages with regard to the reduction of severe bleeding complications. Currently, several prospective randomized studies are being conducted in different patient populations to evaluate the benefit of LAA closure in comparison to standard of care. Currently, LAA closure is recommended in patients after intracranial hemorrhage, with advanced renal failure, after severe gastrointestinal bleeding, in patients with a high risk of recurrent ischemic stroke and elderly patients with high risk of bleeding and falling.

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