Keywords
Atrial Fibrillation
Secondary treatment
Stroke
Disease Prevention
Secondary treatment
Stroke
Disease Prevention
How to Cite
Jiménez Cotes, E., & Meyer Martínez, W. (2014). ¿Es el fin de la anticoagulación con la oclusión percutánea de la orejuela izquierda en fibrilación auricular?. Médicas UIS, 27(3), 69–76. Retrieved from https://revistas.uis.edu.co/index.php/revistamedicasuis/article/view/4886
Abstract
Introduction: atrial fibrillation is the most common arrhythmia in clinical practice. Is associated with a high morbidity and mortality, including stroke, heart failure, and decreased of quality of life. The new oral anticoagulants have a non-negligible hemorrhagic risk, which implies a problem in those patients with high risk bleeding. Is as well percutaneous left atrial appendage closure emerges as an alternative in the treatment of patients with non-valvular atrial fibrillation and thromboembolic high risk or bleeding complications. Objective: to conduct a review article about atrial fibrillation and embolic risk control, with emphasis on the current problems of oral anticoagulation and the use of percutaneous left atrial appendage closure devices. Materials and methods: a systematic search of scientific articles was conducted in different databases, using key words and medical descriptors dealing about atrial fibrillation and the therapeutic methods used in stroke prevention. Results: in total 59 scientific articles were analyzed and theirs findings suggest that the percutaneous left atrial appendage closure is a possible alternative in the treatment of patients with non-valvular atrial fibrillation. Conclusions: the percutaneous left atrial appendage closure is effective in the prevention of stroke in patients with non-valvular atrial fibrillation with the potential advantage of not needing the chronic use of anticoagulants. MÉD.UIS. 2014;27(3):69-76.
Atrial Fibrillation. . Stroke. Disease Prevention.
References
1. Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol. 1994;74(3):236-41.
2. Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med. 1995;98(5):476-84.
3. Wazni O, Wilkoff B, Saliba W. Catheter ablation for atrial fibrillation. N Engl J Med. 2011;365(24):2296-304.
4. Bommer WJ. Current and future alternatives to warfarin for the prevention of stroke in atrial fibrillation. Crit Pathw Cardiol. 2012;11(2):45-54.
5. Loyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasan RS, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004; 110(9):1042-6.
6. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883-91.
7. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace. 2010;12(10):1360-420.
8. Stefansdottir H, Aspelund T, Gudnason V, Arnar DO. Trends in the incidence and prevalence of atrial fibrillation in Iceland and future projections. Europace. 2011;13(8):1110-7.
9. Johnson WD, Ganjoo AK, Stone CD, Srivyas RC, Howard M. The left atrial appendage: our most lethal human attachment! Surgical implications. Eur J Cardiothorac Surg. 2000;17(6):718-22.
10. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61(2):755-9.
11. Conti CR. Atrial fibrillation, transesophageal echo, electrical cardioversion, and anticoagulation. Clin Cardiol. 1994;17(12):639-40.
12. Meincke F, Kuck KH, Bergmann MW. Interventional left atrial appendage occlusion: Alternative to oral anticoagulation for stroke prevention in atrial fibrillation. Herz. 2013;38(3):239-46.
13. Al-Saady NM, Obel OA, Camm AJ. Left atrial appendage: structure, function, and role in thromboembolism. Heart. 1999;82(5):547-54.
14. Bogousslavsky J, Van Melle G, Regli F, Kappenberger L. Pathogenesis of anterior circulation stroke in patients with nonvalvular atrial fibrillation: the Lausanne Stroke Registry. Neurology. 1990;40(7):1046-50.
15. Okura H, Inoue H, Tomon M, Nishiyama S, Yoshikawa T, Yoshida K. Is the left atrium the only embolic source in ischemic stroke patients with nonvalvular atrial fibrillation? Am J Cardiol. 1999;84(10):1259-61.
16. Strachinaru M, Wauthy P, Sanoussi A, Morissens M, Costescu I, Catez E. The left atrial septal pouch as a possible location for thrombus formation. J Cardiovasc Med (Hagerstown) Epub 2013 Mar 13.
17. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146(12):857-67.
18. Reynolds MR, Shah J, Essebag V, Olshansky B, Friedman PA, Hadjis T, et al. Patterns and predictors of warfarin use in patients with new-onset atrial fibrillation from the FRACTAL registry. Am J Cardiol. 2006;97(4):538-43.
19. Hart RG, Halperin JL. Atrial fibrillation and thromboembolism: a decade of progress in stroke prevention. Ann Intern Med. 1999;131(9):688-95.
20. Wolf PA, Dawber TR, Thomas HE Jr, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology. 1978;28(10):973-7.
21. Halperin JL, Hart RG. Atrial fibrillation and stroke: new ideas, persisting dilemmas. Stroke. 1988;19(8):937-41.
22. Hohnloser SH, Pajitnev D, Pogue J, Healey JS, Pfeffer MA, Yusuf S, et al. Incidence of stroke in paroxysmal versus sustained atrial fibrillation in patients taking oral anticoagulation or combined antiplatelet therapy: an ACTIVE W Substudy. J Am Coll Cardiol. 2007;50(22):2156-61.
23. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-8.
24. Garcia DA, Hylek E. Reducing the risk for stroke in patients who have atrial fibrillation. Cardiol Clin. 2008;26(2):267-75.
25. Cruz-Gonzalez I, Yan BP, Lam YY. Left atrial appendage exclusion: state-of-the-art. Catheter Cardiovasc Interv. 2010;75(5):806-13.
26. Kim YL, Joung B, On YK, Shim CY, Lee MH, Kim YH, et al. Early experience using a left atrial appendage occlusion device in patients with atrial fibrillation. Yonsei Med J. 2012;53(1):83-90.
27. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51.
28. Go AS, Hylek EM, Borowsky LH, Phillips KA, Selby JV, Singer DE. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the anticoagulation and risk factors in atrial fi¬brillation (ATRIA) study. Ann Intern Med. 1999;131(12):927-34.
29. Tayal AH, Tian M, Kelly KM, Jones SC, Wright DG, Singh D, et al. Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke. Neurology. 2008;71(21):1696-701.
30. Di Biase L, Santangeli P, Anselmino M, Mohanty P, Salvetti I, Gili S, et al. Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. J Am Coll Cardiol. 2012;60(6):531-8.
31. Freixa X, Tzikas A, Basmadjian A, Garceau P, Ibrahim R. The chicken-wing morphology: an anatomical challenge for left atrial appendage occlusion. J Interv Cardiol. 2013;26(5):509-14.
32. January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC, Cigarroa JE, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014.
33. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981–92.
34. Connolly SJ, Eikelboom J, Joyner C, Diener HC, Hart R, Golitsyn S, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364(9):806-17.
35. Lopes RD, Alexander JH, Al-Khatib SM, Ansell J, Diaz R, Easton JD, et al. Apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation (ARISTOTLE) trial: design and rationale. Am Heart J. 2010;159(3):331-9.
36. del Zoppo GJ, Eliasziw M. New options in anticoagulation for atrial fibrillation. N Engl J Med. 2011;365(10):952-3.
37. Schiele F, van Ryn J, Canada K, Newsome C, Sepulveda E, Park J, et al. A specific antidote for dabigatran: functional and structural characterization. Blood. 2013;121(18):3554-62. [Artículo de revista]
38. Millar CM, Lane DA. Blocking direct inhibitor bleeding. Blood. 2013;121(18):3543-4.
39. Eerenberg ES, Kamphuisen PW, Sijpkens MK, Meijers JC, Buller HR, Levi M. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: a randomized, placebo- controlled, crossover study in healthy subjects. Circulation. 2011;124(14):1573-9.
40. Marlu R, Hodaj E, Paris A, Albaladejo P, Crackowski JL, Pernod G. Effect of non-specific reversal agents on anticoagulant activity of dabigatran and rivaroxaban: a randomised crossover ex vivo study in healthy volunteers. Thromb Haemost. 2012;108(2):217-24.
41. Lévy S. Newer clinically available antithrombotics and their antidotes. J Interv Card Electrophysiol. 2014;40(3):269-75.
42. Fountain RB, Holmes DR, Chandrasekaran K, Packer D, Asirvatham S, Van Tassel R, et al. The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) trial. Am Heart J. 2006;151(5):956-61.
43. Sievert H, Lesh MD, Trepels T, Omran H, Bartorelli A, Della Bella P, et al. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience. Circulation. 2002;105(16):1887-9.
44. Ostermayer SH, Reisman M, Kramer PH, Matthews RV, Gray WA, Block PC, et al. Percutaneous left atrial appendage transcatheter occlusion (PLAATO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: results from the international multi-center feasibility trials. J Am Coll Cardiol. 2005;46(1):9-14.
45. Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet. 2009;374(9689):534-42.
46. Reddy VY, Holmes D, Doshi SK, Neuzil P, Kar S. Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the continued access registry. Circulation. 2011;123(4):417-24.
47. Hernández-Estefania R, Levy B, Rábago G. La orejuela izquierda como fuente de accidentes cerebrovasculares: cerrar (y cómo), o no cerrar (y por qué). An Sist Sanit Navar. 2012;35(1):87-98.
48. Goldman ME, Pearce LA, Hart RG, Zabalgoitia M, Asinger RW, Safford R, et al. Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation: I. Reduced flow velocity in the left atrial appendage (The Stroke Prevention in Atrial Fibrillation [SPAF-III] study). J Am Soc Echocardiogr. 1999;12(12):1080-7.
49. Bayard YL, Omran H, Neuzil P, Thuesen L, Pichler M, Rowland E, et al. PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) for prevention of cardioembolic stroke in non-anticoagulation eligible atrial fibrillation patients: results from the European PLAATO study. EuroIntervention. 2010;6(2):220-6.
50. Swaans MJ, Post MC, Rensing BJ, Boersma LV. Percutaneous left atrial appendage closure for stroke prevention in atrial fibrillation. Neth Heart J. 2012;20(4):161-6.
51. Chiam PT, Ruiz CE. Percutaneous transcatheter left atrial appendage exclusion in atrial fibrillation. J Invasive Cardiol. 2008;20(4):E109-13.
52. Gibson DN, Price MJ, Ahern TS, Teirstein PS. Left atrial appendage occlusion for the reduction of stroke and embolism in patients with atrial fibrillation. J Cardiovasc Med (Hagerstown). 2012;13(2):131-7.
53. Contractor T, Khasnis A. Left atrial appendage closure in atrial fibrillation: a world without anticoagulation? Cardiol Res Pract. 2011;2011:752808.
54. Holmes DR Jr, Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK, et al. Prospective Randomized Evaluation of the Watchman Left Atrial Appendage Closure Device in Patients With Atrial Fibrillation Versus Long-Term Warfarin Therapy: The PREVAIL Trial. J Am Coll Cardiol. 2014;64(1):1-12.
55. Holmes DR Jr, Lakkireddy DR, Whitlock RP, Waksman R, Mack MJ. Left atrial appendage occlusion: opportunities and challenges. J Am Coll Cardiol. 2014;63(4):291-8.
56. Bajaj NS, Parashar A, Agarwal S, Sodhi N, Poddar KL, Garg A, et al. Percutaneous left atrial appendage occlusion for stroke prophylaxis in nonvalvular atrial fibrillation: a systematic review and analysis of observational studies. JACC Cardiovasc Interv. 2014;7(3):296-304.
57. Park JW, Bethencourt A, Sievert H, Santoro G, Meier B, Walsh K, et al. Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation: initial European experience. Catheter Cardiovasc Interv. 2011;77(5):700-6.
58. Faustino A, Paiva L, Providência R, Trigo J, Botelho A, Costa M, et al. Percutaneous closure of the left atrial appendage for prevention of thromboembolism in atrial fibrillation for patients with contraindication to or failure of oral anticoagulation: a single-center experience. Rev Port Cardiol. 2013;32(6):461-71.
59. Freixa X, Abualsaud A, Chan J, Nosair M, Tzikas A, Garceau P, et al. Left atrial appendage occlusion: Initial experience with the Amplatzer™ Amulet™. Int J Cardiol. 2014;174(3):492-6.
2. Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med. 1995;98(5):476-84.
3. Wazni O, Wilkoff B, Saliba W. Catheter ablation for atrial fibrillation. N Engl J Med. 2011;365(24):2296-304.
4. Bommer WJ. Current and future alternatives to warfarin for the prevention of stroke in atrial fibrillation. Crit Pathw Cardiol. 2012;11(2):45-54.
5. Loyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasan RS, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004; 110(9):1042-6.
6. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883-91.
7. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace. 2010;12(10):1360-420.
8. Stefansdottir H, Aspelund T, Gudnason V, Arnar DO. Trends in the incidence and prevalence of atrial fibrillation in Iceland and future projections. Europace. 2011;13(8):1110-7.
9. Johnson WD, Ganjoo AK, Stone CD, Srivyas RC, Howard M. The left atrial appendage: our most lethal human attachment! Surgical implications. Eur J Cardiothorac Surg. 2000;17(6):718-22.
10. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61(2):755-9.
11. Conti CR. Atrial fibrillation, transesophageal echo, electrical cardioversion, and anticoagulation. Clin Cardiol. 1994;17(12):639-40.
12. Meincke F, Kuck KH, Bergmann MW. Interventional left atrial appendage occlusion: Alternative to oral anticoagulation for stroke prevention in atrial fibrillation. Herz. 2013;38(3):239-46.
13. Al-Saady NM, Obel OA, Camm AJ. Left atrial appendage: structure, function, and role in thromboembolism. Heart. 1999;82(5):547-54.
14. Bogousslavsky J, Van Melle G, Regli F, Kappenberger L. Pathogenesis of anterior circulation stroke in patients with nonvalvular atrial fibrillation: the Lausanne Stroke Registry. Neurology. 1990;40(7):1046-50.
15. Okura H, Inoue H, Tomon M, Nishiyama S, Yoshikawa T, Yoshida K. Is the left atrium the only embolic source in ischemic stroke patients with nonvalvular atrial fibrillation? Am J Cardiol. 1999;84(10):1259-61.
16. Strachinaru M, Wauthy P, Sanoussi A, Morissens M, Costescu I, Catez E. The left atrial septal pouch as a possible location for thrombus formation. J Cardiovasc Med (Hagerstown) Epub 2013 Mar 13.
17. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146(12):857-67.
18. Reynolds MR, Shah J, Essebag V, Olshansky B, Friedman PA, Hadjis T, et al. Patterns and predictors of warfarin use in patients with new-onset atrial fibrillation from the FRACTAL registry. Am J Cardiol. 2006;97(4):538-43.
19. Hart RG, Halperin JL. Atrial fibrillation and thromboembolism: a decade of progress in stroke prevention. Ann Intern Med. 1999;131(9):688-95.
20. Wolf PA, Dawber TR, Thomas HE Jr, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology. 1978;28(10):973-7.
21. Halperin JL, Hart RG. Atrial fibrillation and stroke: new ideas, persisting dilemmas. Stroke. 1988;19(8):937-41.
22. Hohnloser SH, Pajitnev D, Pogue J, Healey JS, Pfeffer MA, Yusuf S, et al. Incidence of stroke in paroxysmal versus sustained atrial fibrillation in patients taking oral anticoagulation or combined antiplatelet therapy: an ACTIVE W Substudy. J Am Coll Cardiol. 2007;50(22):2156-61.
23. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-8.
24. Garcia DA, Hylek E. Reducing the risk for stroke in patients who have atrial fibrillation. Cardiol Clin. 2008;26(2):267-75.
25. Cruz-Gonzalez I, Yan BP, Lam YY. Left atrial appendage exclusion: state-of-the-art. Catheter Cardiovasc Interv. 2010;75(5):806-13.
26. Kim YL, Joung B, On YK, Shim CY, Lee MH, Kim YH, et al. Early experience using a left atrial appendage occlusion device in patients with atrial fibrillation. Yonsei Med J. 2012;53(1):83-90.
27. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51.
28. Go AS, Hylek EM, Borowsky LH, Phillips KA, Selby JV, Singer DE. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the anticoagulation and risk factors in atrial fi¬brillation (ATRIA) study. Ann Intern Med. 1999;131(12):927-34.
29. Tayal AH, Tian M, Kelly KM, Jones SC, Wright DG, Singh D, et al. Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke. Neurology. 2008;71(21):1696-701.
30. Di Biase L, Santangeli P, Anselmino M, Mohanty P, Salvetti I, Gili S, et al. Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. J Am Coll Cardiol. 2012;60(6):531-8.
31. Freixa X, Tzikas A, Basmadjian A, Garceau P, Ibrahim R. The chicken-wing morphology: an anatomical challenge for left atrial appendage occlusion. J Interv Cardiol. 2013;26(5):509-14.
32. January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC, Cigarroa JE, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014.
33. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981–92.
34. Connolly SJ, Eikelboom J, Joyner C, Diener HC, Hart R, Golitsyn S, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364(9):806-17.
35. Lopes RD, Alexander JH, Al-Khatib SM, Ansell J, Diaz R, Easton JD, et al. Apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation (ARISTOTLE) trial: design and rationale. Am Heart J. 2010;159(3):331-9.
36. del Zoppo GJ, Eliasziw M. New options in anticoagulation for atrial fibrillation. N Engl J Med. 2011;365(10):952-3.
37. Schiele F, van Ryn J, Canada K, Newsome C, Sepulveda E, Park J, et al. A specific antidote for dabigatran: functional and structural characterization. Blood. 2013;121(18):3554-62. [Artículo de revista]
38. Millar CM, Lane DA. Blocking direct inhibitor bleeding. Blood. 2013;121(18):3543-4.
39. Eerenberg ES, Kamphuisen PW, Sijpkens MK, Meijers JC, Buller HR, Levi M. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: a randomized, placebo- controlled, crossover study in healthy subjects. Circulation. 2011;124(14):1573-9.
40. Marlu R, Hodaj E, Paris A, Albaladejo P, Crackowski JL, Pernod G. Effect of non-specific reversal agents on anticoagulant activity of dabigatran and rivaroxaban: a randomised crossover ex vivo study in healthy volunteers. Thromb Haemost. 2012;108(2):217-24.
41. Lévy S. Newer clinically available antithrombotics and their antidotes. J Interv Card Electrophysiol. 2014;40(3):269-75.
42. Fountain RB, Holmes DR, Chandrasekaran K, Packer D, Asirvatham S, Van Tassel R, et al. The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) trial. Am Heart J. 2006;151(5):956-61.
43. Sievert H, Lesh MD, Trepels T, Omran H, Bartorelli A, Della Bella P, et al. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience. Circulation. 2002;105(16):1887-9.
44. Ostermayer SH, Reisman M, Kramer PH, Matthews RV, Gray WA, Block PC, et al. Percutaneous left atrial appendage transcatheter occlusion (PLAATO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: results from the international multi-center feasibility trials. J Am Coll Cardiol. 2005;46(1):9-14.
45. Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet. 2009;374(9689):534-42.
46. Reddy VY, Holmes D, Doshi SK, Neuzil P, Kar S. Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the continued access registry. Circulation. 2011;123(4):417-24.
47. Hernández-Estefania R, Levy B, Rábago G. La orejuela izquierda como fuente de accidentes cerebrovasculares: cerrar (y cómo), o no cerrar (y por qué). An Sist Sanit Navar. 2012;35(1):87-98.
48. Goldman ME, Pearce LA, Hart RG, Zabalgoitia M, Asinger RW, Safford R, et al. Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation: I. Reduced flow velocity in the left atrial appendage (The Stroke Prevention in Atrial Fibrillation [SPAF-III] study). J Am Soc Echocardiogr. 1999;12(12):1080-7.
49. Bayard YL, Omran H, Neuzil P, Thuesen L, Pichler M, Rowland E, et al. PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) for prevention of cardioembolic stroke in non-anticoagulation eligible atrial fibrillation patients: results from the European PLAATO study. EuroIntervention. 2010;6(2):220-6.
50. Swaans MJ, Post MC, Rensing BJ, Boersma LV. Percutaneous left atrial appendage closure for stroke prevention in atrial fibrillation. Neth Heart J. 2012;20(4):161-6.
51. Chiam PT, Ruiz CE. Percutaneous transcatheter left atrial appendage exclusion in atrial fibrillation. J Invasive Cardiol. 2008;20(4):E109-13.
52. Gibson DN, Price MJ, Ahern TS, Teirstein PS. Left atrial appendage occlusion for the reduction of stroke and embolism in patients with atrial fibrillation. J Cardiovasc Med (Hagerstown). 2012;13(2):131-7.
53. Contractor T, Khasnis A. Left atrial appendage closure in atrial fibrillation: a world without anticoagulation? Cardiol Res Pract. 2011;2011:752808.
54. Holmes DR Jr, Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK, et al. Prospective Randomized Evaluation of the Watchman Left Atrial Appendage Closure Device in Patients With Atrial Fibrillation Versus Long-Term Warfarin Therapy: The PREVAIL Trial. J Am Coll Cardiol. 2014;64(1):1-12.
55. Holmes DR Jr, Lakkireddy DR, Whitlock RP, Waksman R, Mack MJ. Left atrial appendage occlusion: opportunities and challenges. J Am Coll Cardiol. 2014;63(4):291-8.
56. Bajaj NS, Parashar A, Agarwal S, Sodhi N, Poddar KL, Garg A, et al. Percutaneous left atrial appendage occlusion for stroke prophylaxis in nonvalvular atrial fibrillation: a systematic review and analysis of observational studies. JACC Cardiovasc Interv. 2014;7(3):296-304.
57. Park JW, Bethencourt A, Sievert H, Santoro G, Meier B, Walsh K, et al. Left atrial appendage closure with Amplatzer cardiac plug in atrial fibrillation: initial European experience. Catheter Cardiovasc Interv. 2011;77(5):700-6.
58. Faustino A, Paiva L, Providência R, Trigo J, Botelho A, Costa M, et al. Percutaneous closure of the left atrial appendage for prevention of thromboembolism in atrial fibrillation for patients with contraindication to or failure of oral anticoagulation: a single-center experience. Rev Port Cardiol. 2013;32(6):461-71.
59. Freixa X, Abualsaud A, Chan J, Nosair M, Tzikas A, Garceau P, et al. Left atrial appendage occlusion: Initial experience with the Amplatzer™ Amulet™. Int J Cardiol. 2014;174(3):492-6.
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