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Raja F, Rani K, Kumar S, Someshwar F, Naseer Khan MA, Abubakar F, Bhatt D, Subedi DJ, Shadmani S, Zahra Abdullah FT. Comparative Profiles of the WATCHMAN™ and Amplatzer™ Cardiac Plug/Amplatzer™ Amulet™ Devices for Left Atrial Appendage Closure in Non-valvular Atrial Fibrillation: A Comprehensive Systematic Review and Meta-analysis. J Innov Card Rhythm Manag 2024; 15:5917-5929. [PMID: 38948665 PMCID: PMC11210678 DOI: 10.19102/icrm.2024.15061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/19/2024] [Indexed: 07/02/2024] Open
Abstract
Atrial fibrillation (AF) is a prevalent cardiac arrhythmia marked by irregular and frequent tachycardic rhythms in the atria, affecting 1%-2% of the general population. The WATCHMAN™ device from Boston Scientific (Marlborough, MA, USA) and the Amplatzer™ Amulet™ device from Abbott (Chicago, IL, USA) are two devices used globally for left atrial appendage closure (LAAC) in non-valvular AF. A systematic search was conducted in PubMed, the Cochrane Library, and Elsevier's ScienceDirect literature databases to identify studies comparing the WATCHMAN™ procedure with Amulet™ device implantation for LAAC in patients with AF. The analyses were conducted using the random-effects model. A total of 20 studies were identified, with 18 falling into the category of observational studies and 2 being randomized controlled trials. A total of 6310 participants were included in this meta-analysis, with 3198 individuals (50.68%) assigned to the WATCHMAN™ procedure group and 3112 individuals (49.32%) allocated to the Amplatzer™ Cardiac Plug (ACP) group. The analysis revealed a higher risk of stroke associated with the WATCHMAN™ technique (relative risk [RR], 1.14), albeit without statistical significance. Conversely, the WATCHMAN™ approach led to a significantly lower risk of cardiac death (RR, 0.44; P = .04). Notably, the risks of all-cause mortality (RR, 0.89; 95% confidence interval [CI], 0.73-1.08; I 2 = 0%; P = .25) and major bleeding (RR, 0.93; 95% CI, 0.65-1.33; I 2 = 31%; P = .70) were clinically reduced with the WATCHMAN™ procedure, although statistical significance was not achieved. Compared to Amulet™ device implantation, WATCHMAN™ device implantation decreased the risk of cardiac mortality, while the risks of stroke, systemic embolism, all-cause mortality, and major bleeding were not statistically significant.
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Affiliation(s)
- Fnu Raja
- Department of Internal Medicine, Federal Medical and Dental College, Islamabad, Pakistan
| | - Khimya Rani
- Department of Internal Medicine, Chandka Medical College SMBBMU, Larkana, Pakistan
| | - Sunny Kumar
- Department of Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Fnu Someshwar
- Department of Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | - Fnu Abubakar
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Dhvani Bhatt
- Department of Internal Medicine, American University of Barbados, Bridgetown, Barbados
| | - Deepak Jung Subedi
- Department of Internal Medicine, College of Medical Sciences, Bharatpur, Nepal
| | - Sujeet Shadmani
- Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
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Singh SM, Qui F, Wijeysundera HC. Long-term Clinical Outcomes in Contemporary Patients Undergoing Left Atrial Appendage Occlusion Procedures in Ontario, Canada. CJC Open 2023; 5:770-778. [PMID: 37876880 PMCID: PMC10591127 DOI: 10.1016/j.cjco.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 10/26/2023] Open
Abstract
Background Percutaneous left atrial appendage occlusion (LAAO) is an alternative for stroke prevention in patients with atrial fibrillation with contraindications to oral anticoagulation. Population-level real-world data describing the use and outcomes of LAAO procedures are evolving, with a paucity of longer-term follow-up data. We report on the patient characteristics, procedure complications, and longer-term clinical outcomes in all patients undergoing LAAO procedures in Ontario, Canada. Methods All patients undergoing LAAO procedure between April 1, 2013 and March 31, 2022 were identified. Linked administrative databases were utilized to determine patient clinical and procedural characteristics. Outcomes of interest included procedural complications at 7 and 30 days, and longer-term rates of stroke, bleeding, all-cause rehospitalization, and mortality. Results A total of 549 individuals were included in the study cohort. The average age was 75 ± 8 years, with 66% being of male sex, with a mean CHA2DS2VASc score of 4.4 ± 1.6, and with 68% not receiving oral anticoagulation. Follow-up for 2.6 ± 2.0 patient-years was available. Stroke occurred in 2.8% during the follow-up period (1.1 per 100 patient-years), bleeding in 10% (4.0 per 100 patient-years), and any hospital readmission in 63% (43 per 100 patient-years). A total of 29% of the cohort died during the follow-up period (11 per 100 patient-years), with 1.8% of the cohort dying during the procedural hospitalization. The mortality rate was unchanged during the study period (P for trend = 0.72). Conclusions Long-term stroke and bleeding rates are low in patients undergoing LAAO procedures in Ontario, Canada. All-cause mortality in this population is high and remained unchanged during the study period.
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Affiliation(s)
- Sheldon M. Singh
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Harindra C. Wijeysundera
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Ahmed A, Bawa D, Kabra R, Pothineni NVK, Darden D, Gopinathannair R, Lakkireddy D. Left Atrial Appendage Closure with Watchman vs Amulet Devices: Similarities and Differences. Curr Cardiol Rep 2023; 25:909-915. [PMID: 37584874 DOI: 10.1007/s11886-023-01913-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE OF REVIEW Left atrial appendage closure (LAAC) has shown to be non-inferior to oral anticoagulation (OAC) for non-valvular atrial fibrillation (AF). LAAC is now becoming a leading method for stroke prophylaxis in patients who have atrial fibrillation and are unable to tolerate OAC. There are currently two FDA-approved endocardial closure devices, namely, the Watchman FLX and Amplatzer Amulet. RECENT FINDINGS Current data highlights 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 regard to peri-device leaks, device-related thrombosis, and mortality. With similar risk and safety profiles, both devices are indicated for patients who are unable to tolerate OAC. Newer clinical studies are directed to establish the efficacy of both devices as the primary method for stroke prevention in AF as an alternate to OAC.
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Affiliation(s)
- Adnan Ahmed
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | - Danish Bawa
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | | | - Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
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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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Not to Rush-Laboratory Parameters and Procedural Complications in Patients Undergoing Left Atrial Appendage Closure. J Clin Med 2022; 11:jcm11216548. [PMID: 36362774 PMCID: PMC9656817 DOI: 10.3390/jcm11216548] [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: 10/15/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Background: As a preventive procedure, minimizing periprocedural risk is crucially important during left atrial appendage closure (LAAC). Methods: We included consecutive patients receiving LAAC at nine centres and assessed the relationship between baseline characteristics and the acute procedural outcome. Major procedural complications were defined as all complications requiring immediate invasive intervention or causing irreversible damage. Logistic regression was performed and included age and left-ventricular function. Furthermore, the association between acute complications and long-term outcomes was evaluated. Results: A total of 405 consecutive patients with a median age of 75 years (37% female) were included. 47% had a history of stroke. Median CHA2DS2-VASc score was 4 (interquartile range, 3−5) and the median HAS-BLED score was 3 (2−4). Major procedural complications occurred in 7% of cases. Low haemoglobin (OR 0.8, 95% CI 0.65−0.99 per g/dL, p = 0.040) and end-stage kidney disease (OR 13.0, CI 2.5−68.5, p = 0.002) remained significant in multivariate analysis. Anaemia (haemoglobin < 12 and < 13 g/dL in female and male patients) increased the risk of complications 2.2-fold. Conclusions: The major complication rate was low in this high-risk patient population undergoing LAAC. End-stage kidney disease and low baseline haemoglobin were independently associated with a higher major complication rate.
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