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Frazzetto M, Sanfilippo C, Costa G, Contrafatto C, Giacalone C, Scandura S, Castania G, De Santis J, Sanfilippo M, Di Salvo ME, Tamburino C, Barbanti M, Grasso C. Watchman vs. Amulet for Left Atrial Appendage Closure: Current Evidence and Future Perspectives. J Clin Med 2024; 13:4651. [PMID: 39200792 PMCID: PMC11355803 DOI: 10.3390/jcm13164651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/25/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Left atrial appendage closure (LAAC) is a crucial intervention for stroke prevention in patients with non-valvular atrial fibrillation who are unsuitable for long-term anticoagulation. Amulet and Watchman are the most implanted devices worldwide for performing LAAC, and the aim of this review is to provide a comprehensive comparison focusing on their efficacy, safety, and short- and long-term outcomes. The Watchman device, the first to gain FDA approval, has been extensively studied and demonstrates significant reductions in stroke and systemic embolism rates. The Amulet device, a newer alternative, promises enhanced design features for more efficient appendage sealing. Current data highlight that both devices offer similar efficacy and safety for LAAC. While the two devices differ in terms of intraprocedural complication rates, they offer similar short- to long-term outcomes in terms of peri-device leaks, device-related thrombosis, and mortality. Both devices are indicated for patients who are unable to tolerate OAC, given their similar risk and safety profiles. Newer clinical studies are directed at establishing the efficacy of both devices as the primary method for stroke prevention in AF as an alternative to OAC.
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Affiliation(s)
- Marco Frazzetto
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico San Marco”, 95123 Catania, Italy; (C.S.); (G.C.); (C.C.); (C.G.); (S.S.); (G.C.); (J.D.S.); (M.S.); (M.E.D.S.); (C.T.); (C.G.)
| | - Claudio Sanfilippo
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico San Marco”, 95123 Catania, Italy; (C.S.); (G.C.); (C.C.); (C.G.); (S.S.); (G.C.); (J.D.S.); (M.S.); (M.E.D.S.); (C.T.); (C.G.)
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico San Marco”, 95123 Catania, Italy; (C.S.); (G.C.); (C.C.); (C.G.); (S.S.); (G.C.); (J.D.S.); (M.S.); (M.E.D.S.); (C.T.); (C.G.)
| | - Claudia Contrafatto
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico San Marco”, 95123 Catania, Italy; (C.S.); (G.C.); (C.C.); (C.G.); (S.S.); (G.C.); (J.D.S.); (M.S.); (M.E.D.S.); (C.T.); (C.G.)
| | - Chiara Giacalone
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico San Marco”, 95123 Catania, Italy; (C.S.); (G.C.); (C.C.); (C.G.); (S.S.); (G.C.); (J.D.S.); (M.S.); (M.E.D.S.); (C.T.); (C.G.)
| | - Salvatore Scandura
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico San Marco”, 95123 Catania, Italy; (C.S.); (G.C.); (C.C.); (C.G.); (S.S.); (G.C.); (J.D.S.); (M.S.); (M.E.D.S.); (C.T.); (C.G.)
| | - Giuseppe Castania
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico San Marco”, 95123 Catania, Italy; (C.S.); (G.C.); (C.C.); (C.G.); (S.S.); (G.C.); (J.D.S.); (M.S.); (M.E.D.S.); (C.T.); (C.G.)
| | - Jessica De Santis
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico San Marco”, 95123 Catania, Italy; (C.S.); (G.C.); (C.C.); (C.G.); (S.S.); (G.C.); (J.D.S.); (M.S.); (M.E.D.S.); (C.T.); (C.G.)
| | - Maria Sanfilippo
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico San Marco”, 95123 Catania, Italy; (C.S.); (G.C.); (C.C.); (C.G.); (S.S.); (G.C.); (J.D.S.); (M.S.); (M.E.D.S.); (C.T.); (C.G.)
| | - Maria Elena Di Salvo
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico San Marco”, 95123 Catania, Italy; (C.S.); (G.C.); (C.C.); (C.G.); (S.S.); (G.C.); (J.D.S.); (M.S.); (M.E.D.S.); (C.T.); (C.G.)
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico San Marco”, 95123 Catania, Italy; (C.S.); (G.C.); (C.C.); (C.G.); (S.S.); (G.C.); (J.D.S.); (M.S.); (M.E.D.S.); (C.T.); (C.G.)
| | - Marco Barbanti
- Faculty of Medicine and Surgery, Università degli Studi di Enna “Kore”, 94100 Enna, Italy;
- Division of Cardiology, Ospedale Umberto I, ASP 4 di Enna, 94100 Enna, Italy
| | - Carmelo Grasso
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico San Marco”, 95123 Catania, Italy; (C.S.); (G.C.); (C.C.); (C.G.); (S.S.); (G.C.); (J.D.S.); (M.S.); (M.E.D.S.); (C.T.); (C.G.)
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Święczkowski M, Dąbrowski EJ, Muszyński P, Pogorzelski P, Jemielita P, Dudzik JM, Januszko T, Duzinkiewicz M, Południewski M, Kuźma Ł, Kożuch M, Kralisz P, Dobrzycki S. A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion. J Cardiovasc Dev Dis 2024; 11:234. [PMID: 39195142 DOI: 10.3390/jcdd11080234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 08/29/2024] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide, and is associated with a significant risk of thromboembolic events. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative for patients with contraindications or intolerance to anticoagulant therapy. This review summarises the current evidence, indications, and technical advancements in surgical and percutaneous LAAO. Preprocedural planning relies on various imaging techniques, each with unique advantages and limitations. The existing randomised clinical trials and meta-analyses demonstrate favourable results for both percutaneous and surgical LAAO. Postprocedural management emphasises personalised anticoagulation strategies and comprehensive imaging surveillance to ensure device stability and detect complications. Future focus should be put on antithrombotic regimens, investigating predictors of device-related complications, and simplifying procedural aspects to enhance patient outcomes. In summary, LAAO is presented as a valuable therapeutic option for preventing AF-related thromboembolic events, with ongoing research aimed at refining techniques and improving patient care.
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Affiliation(s)
- Michał Święczkowski
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Emil Julian Dąbrowski
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Paweł Muszyński
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Piotr Pogorzelski
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Piotr Jemielita
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Joanna Maria Dudzik
- Second Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Tomasz Januszko
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Małgorzata Duzinkiewicz
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Maciej Południewski
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Marcin Kożuch
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Paweł Kralisz
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St., 15-276 Bialystok, Poland
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Rajiah PS. Imaging Evaluation Following Transcatheter Left Atrial Appendage Closure. Semin Roentgenol 2024; 59:121-134. [PMID: 38388091 DOI: 10.1053/j.ro.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 02/24/2024]
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Choe YH. Association of Hypoattenuation Thickening at CT after Left Atrial Appendage Occlusion with Stroke. Radiology 2023; 308:e231828. [PMID: 37668525 DOI: 10.1148/radiol.231828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Yeon Hyeon Choe
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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Guarracini F, Bonvicini E, Preda A, Martin M, Muraglia S, Casagranda G, Mochen M, Coser A, Quintarelli S, Branzoli S, Bonmassari R, Marini M, Mazzone P. Appropriate Use Criteria of Left Atrial Appendage Closure Devices: Latest Evidences. Expert Rev Med Devices 2023; 20:493-503. [PMID: 37128658 DOI: 10.1080/17434440.2023.2208748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Atrial fibrillation is the most common arrythmia and it is linked to an increased risk of stroke. Even if anticoagulation therapy reduces the rate of stroke the benefits of this therapy have to been balanced with the increased risk of hemorrhagic event. Left atrial appendage closure is a valid alternative to long term anticoagulation in patients with atrial fibrillation and high hemorrhagic risk. Actually new devices with different features have been tested and introduced progressively in the clinical practice. Improvements preprocedural imaging evaluation and the learning curve of the operators led to percutaneous left atrial appendage closure a safe and effective procedure. A good knowledge of different devices and the technique of implant is necessary for optimization percutaneous left atrial appendage closure and the reduction of complications during the acute phase and follow up.
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Affiliation(s)
| | | | - Alberto Preda
- Cardiothoracovascular Department, Electrophysiology Unit, Niguarda Hospital, Milano, Italy
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | | | | | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | | | | | | | | | - Patrizio Mazzone
- Cardiothoracovascular Department, Electrophysiology Unit, Niguarda Hospital, Milano, Italy
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