Percutaneous left atrial appendage closure (LAA)
Percutaneous left atrial appendage closure is an invasive technique that has been developed recently and has shown very promising results in the prevention of stroke in patients with atrial fibrillation. The procedure is performed in the cath lab and requires hospitalization for 1-2 days. Inclusion and exclusion criteria are as follows:
- Paroxysmal, persistent or chronic, non-valvular, atrial fibrillation with high annual risk for stroke (CHADS2 Score ≥ 2).
- Failure or contraindication for anticoagulation therapy (either with Sintrom or newer anticoagulants).
- Age> 18 years.
- Presence of thrombus in the left atrium.
- Pregnancy – Lactation.
For reasons of better imaging and patient safety, during the operation we use transesophageal echocardiography, so in most cases the patient is under general anesthesia. The access is made from the right femoral vein, with puncture of the interatrial septum. The usual duration of the procedure is 2 hours. After the operation, the patient is hospitalized for a few hours in the coronary care unit and then in the ward. Post-procedure, the patient is prescribed dual antiplatelet therapy for 1 month (aspirin 100 mg – clopidogrel, Plavix 75 mg) and then only aspirin 100 mg for 6 months.
During my post-graduate training in Canada, I had the opportunity to use and be trained on the use of the Amplatzer Cardiac Plug device. At the same time, I participated in two studies, which aimed to improve the implantation and imaging technique for this device. Regarding the effectiveness of the method in the prevention of stroke, published studies (and the experience so far in Canada) show that it is at least as good as the well-controlled anticoagulant therapy. The occlusion of the appendage is achieved in> 95% and is permanent.
Percutaneous left atrial appendage closure is not a substitute for standard therapy for stroke prevention in patients with atrial fibrillation, but gives an alternative for those who, while they are at high risk, cannot take anticoagulants. Epidemiological studies show that there is a significant number of such patients in Greece who could benefit from this new invasive treatment. Updating the medical community is the first step in this direction. Finally, it should be noted that many insurance carriers cover the method.