The Clinical Impact of Incomplete Left Atrial Appendage Closure With the Watchman Device in Patients With Atrial Fibrillation
The Clinical Impact of Incomplete Left Atrial Appendage Closure With the Watchman Device in Patients With Atrial Fibrillation
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DOI：
10.1016/j.jacc.2011.11.028
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发表时间：
2012-03-06
影响因子：
24
通讯作者：
Reddy, Vivek Y.
中科院分区：
文献类型：
--
作者：
Viles-Gonzalez, Juan F.;Kar, Saibal;Reddy, Vivek Y.
目的探讨应用Watchman封堵器(明尼苏达州普利茅斯Atritech公司)经皮封堵左心耳(LAA)时左心耳(LAA)封堵不全的发生率和临床影响。背景：在经皮封堵左心耳预防卒中的过程中，左心耳开口的几何变异可能导致封堵不全。一方面，这可能会促进血栓的形成和装置周围血栓的栓塞进入循环；另一方面，这些泄漏的相对较小的规模可能会排除临床相关的栓塞。方法随机分配到在Protect AF(经皮关闭左心耳与华法林疗法预防中风的房颤患者)试验中植入装置的患者进行分析。分别于45天、6个月、12个月行经食道超声心动图检查。根据研究方案，如果45天的经食道超声心动图显示装置周围血流(JET)很少或没有，患者就停止华法林治疗
Objectives The purpose of this study was to investigate the frequency and clinical impact of incomplete left atrial appendage (LAA) sealing and consequent peri-device residual blood flow in patients undergoing percutaneous LAA closure with the Watchman device (Atritech, Inc., Plymouth, Minnesota).Background During percutaneous LAA closure for stroke prophylaxis, the geometric variability of the LAA ostium may result in an incomplete seal of the LAA. On the one hand, this could enhance thrombus formation and embolization of thrombi around the device into the circulation; on the other hand, the relatively small size of these leaks may preclude clinically relevant embolizations.Methods Patients randomly assigned to device implantation in the PROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation) trial were analyzed. Transesophageal echocardiography was performed at 45 days, 6 months, and 12 months. Per the study protocol, patients discontinued warfarin therapy if the 45-day Transesophageal echocardiogram revealed either minimal or no peri-device flow (jet