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Early Experience Using a Left Atrial Appendage Occlusion Device in Patients with Atrial Fibrillation

Authors
Kim, Yung LyJoung, BoyoungOn, Young KeunShim, Chi YoungLee, Moon HyoungKim, Young-HoonPak, Hui-Nam
Issue Date
1-1월-2012
Publisher
YONSEI UNIV COLLEGE MEDICINE
Keywords
Atrial fibrillation; left atrial appendage; occlusion device; thromboembolism
Citation
YONSEI MEDICAL JOURNAL, v.53, no.1, pp.83 - 90
Indexed
SCIE
SCOPUS
KCI
Journal Title
YONSEI MEDICAL JOURNAL
Volume
53
Number
1
Start Page
83
End Page
90
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/106223
DOI
10.3349/ymj.2012.53.1.83
ISSN
0513-5796
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: I) 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 carchoversion for rhythm control. 2) The mean LA size was 51.3 +/- 5.0 mm and LAA size was 25.1 x30.1 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 transesophageal 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.
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