Percutaneous methods of left atrial appendage exclusion: an alternative to the internist

Figures & data

Fig. 1 PLAATO Device (26).

Table 1 Comparison table between devices

Study	Year	Study Type	Device	Subjects (N)	Follow-up	Stroke Outcome	Procedure-Related Death	Complications (No. of Persons)	Efficacy
Ostermayer et al. (12)	2005	Prospective	PLAATO	111	10 months	Stroke/TIA 2.2% (versus estimated 6.3%)	6	Implant failure (3), hemopericardium (5)	65% reduction in stroke risk
Block et al. (13)	2009	Prospective	PLAATO	64	5 years	Stroke 3.8% (versus estimated 6.6%)	1	Death and cardiac tamponade (1), major stroke (5), minor stroke (3)	42% reduction in stroke risk
Meier et al. (16)	2003	Prospective	ACP	16	Average 4 months (range 1–12)	0% stroke/TIA	0	Device embolization (1)	Stable implantation with average of 4 months
Nietlispach et al. (17)	2013	Prospective	ACP (dedicated and non-dedicated)	152	Mean 32 months (range 1–120)	2 TIA and 1 minor stroke (non-dedicated device) and 0 for ACP device	0	Short-term outcome (< 6 months): Neurologic events (2), Cardiac tamponade (4), Device embolization (7), non-cardiac death (1)Intermediate-term outcome (> 6 months): Cardiovascular death (5), non-cardiac death (7), unexplained death (3), neurological events (2), systemic embolization (1), major bleed (4)	Improved short-term outcome with dedicated ACP device, safety events occur approximately 7% of patients, intermediate-term outcome (>6 months) excellent, device thrombus (16%)
Sick et al. (19)	2007	Prospective	WATCHMAN	75	2 years	0% stroke/TIA	1	Implant failure (2), device failure, embolization, or pericardial effusion (6), TIA's (2)	Warfarin could be stopped at 6 months in 97.1% of patients
PROTECT AF (21)	2009	Randomized controlled trial	WATCHMAN	707	18 months	2.3%; 6 years	3%; 4 years	Adverse events higher among controls	>99% probability of non-inferior to warfarin
ASAP (22)	2012	Prospective	WATCHMAN	150	3 and 12 months (mean of 14.2±8.7 months)	75% reduction in ischemic stroke with aspirin (7.1% reduction) vs. aspirin and clopidogrel (5% reduction).	Unknown	Total stroke (4), systemic embolism (1), device-related thrombus by TEE(6)	Watchman without warfarin post-device implantation is safe and effective.
Bartus et al. (24)	2011	Feasibility	LARIAT	13	60 days	0% stroke/TIA	0	Hemopericardium (1)	Technically feasible in humans
Bartus et al. (25)	2012	Prospective	LARIAT	89	12 months	2 Non-embolic stroke	2	Right ventricular puncture (1), laceration of epigastric vessels (1), hemopericardium (1), pericarditis (2)	98% complete LAA closure at 1 year

ACP, Amplatzer Cardiac Plug; PLAATO, percutaneous left atrial appendage transcatheter occlusion; TIA, transient ischemic attack.

Fig. 2 Amplatzer Cardiac Plug (27).

Fig. 3 WATCHMAN Device (28).

Fig. 4 LARIAT Device (29).

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