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Early experience using a left atrial appendage occlusion device in patients with atrial fibrillation

 Yung Ly Kim  ;  Boyoung Joung  ;  Young Keun On  ;  Chi Young Shim  ;  Moon Hyoung Lee  ;  Young-Hoon Kim  ;  Hui-Nam Pak 
 YONSEI MEDICAL JOURNAL, Vol.53(1) : 83-90, 2012 
Journal Title
Issue Date
Aged ; Anticoagulants ; Atrial Appendage/physiopathology* ; Atrial Fibrillation/epidemiology ; Atrial Fibrillation/physiopathology* ; Atrial Fibrillation/surgery* ; Contraindications ; Humans ; Male ; Middle Aged ; Risk Factors ; Septal Occluder Device* ; Stroke/epidemiology ; Stroke/prevention & control* ; Treatment Outcome ; Warfarin
Atrial fibrillation ; left atrial appendage ; occlusion device ; thromboembolism
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yung Ly(김영리)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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