Intracardiac echocardiography for implantation of LAA occlusion devices: A further step toward the ICE era?

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with an increased risk of ischemic stroke (from fewer than 2 to more than 10 strokes per 100 patient-years). 1 Wolf P.A. Dawber T.R. Thomas Jr, H.E. Kannel W.B. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology. 1978; 28: 973-977 Crossref PubMed Google Scholar , 2 Flegel K.M. Shipley M.J. Rose G. Risk of stroke in non-rheumatic atrial fibrillation. Lancet. 1987; 1: 526-529 Abstract PubMed Scopus (313) Google Scholar Thromboembolic complications generally result from left atrium thrombi, the left atrial appendage (LAA) being the most common source of thrombus formation, with an incidence of 91% in patients with nonvalvular AF. 3 Fuster V. Ryden L.E. Cannom D.S. Crijns H.J. Curtis A.B. Ellenbogen K.A. Halperin J.L. Le Heuzey J.Y. Kay G.N. Lowe J.E. Olsson S.B. Prystowsky E.N. Tamargo J.L. Wann S. Smith Jr, S.C. Jacobs A.K. Adams C.D. Anderson J.L. Antman E.M. Halperin J.L. Hunt S.A. Nishimura R. Ornato J.P. Page R.L. Riegel B. Priori S.G. Blanc J.J. Budaj A. Camm A.J. Dean V. Deckers J.W. Despres C. Dickstein K. Lekakis J. McGregor K. Metra M. Morais J. Osterspey A. Tamargo J.L. Zamorano J.L. Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: e257-e354 Crossref PubMed Scopus (2006) Google Scholar , 4 Blackshear J.L. Odell J.A. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996; 61: 755-759 Abstract Full Text PDF PubMed Scopus (1157) Google Scholar Thus, in patients at high risk of stroke with absolute contraindication or failure of oral anticoagulation therapy, a new device recently has been developed to obliterate and exclude LAA from the circulation via a percutaneous approach (PLAATO system, ev3 Inc., Plymouth, Minnesota). 5 Nakai T. Lesh M.D. Gerstenfeld E.P. Virmani R. Jones R. Lee R.J. Percutaneous left atrial appendage occlusion (PLAATO) for preventing cardioembolism: first experience in canine model. Circulation. 2002; 105: 2217-2222 Crossref PubMed Scopus (137) Google Scholar , 6 Sievert H. Lesh M.D. Trepels T. Omran H. Bartorelli A. Della Bella P. Nakai T. Reisman M. DiMario C. Block P. Kramer P. Fleschenberg D. Krumsdorf U. Scherer D. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience. Circulation. 2002; 105: 1887-1889 Crossref PubMed Scopus (386) Google Scholar , 7 Ostermayer S.H. Reisman M. Kramer P.H. Matthews R.V. Gray W.A. Block P.C. Omran H. Bartorelli A.L. Della Bella P. Di Mario C. Pappone C. Casale P.N. Moses J.W. Poppas A. Williams D.O. Meier B. Skanes A. Teirstein P.S. Lesh M.D. Nakai T. Bayard Y. Billinger K. Trepels T. Krumsdorf U. Sievert H. Percutaneous left atrial appendage transcatheter occlusion (PLAATO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: results from the international multi-center feasibility trials. J Am Coll Cardiol. 2005; 46: 9-14 Abstract Full Text Full Text PDF PubMed Scopus (411) Google Scholar