IMMEDIATE AND LONG-TERM RESULTS OF THE LEFT ATRIUM AURICLE OCCLUDER IMPLANTING IN ATRIAL FIBRILLATION

Aim. To evaluate the safety and efficacy of the “WATCHMAN” occluder (OW) in atrial fibrillation patients (AF) during hospital period and in 12 months after the procedure.

Material and methods. Frоm 2013 to 2015 years, in the N. A. Semashko Central clinical hospital № 2 of “RZD”, 15 OW were implanted to patients with persistent AF of non-rheumatic origin, admitted for electro cardioversion, or electrophysiological study and radiofrequency ablation, pacemaker implantation. Indications for endovascular intervention were the threat of repeated embolism, high bleeding risk, severe comorbidities, and inefficacy of antithrombotic therapy. From the study were excluded those with stenosis of the left atrioventricular space and thrombi in the left atrium auricle (LAA). During pre-surgery period, all patients underwent standard transthoracal and transesophageal echocardiography for assessment of the LAA anatomy, its size in four points of view and its position to the left upper pulmonary vein. For stroke risk assessment and of thromboemolic complications the score CHA₂ DS₂ was used and its new edition CHA₂ DS₂ -VASc. Before the discharge from clinic, all patients underwent transesophageal echocardiography, repeated in 6 weeks, 6 and 12 months.

Results. Mean age of patients was 52 year old. All patients had successful OW implanting. Interventions were done without general anesthesia, under local anesthesia. Mean duration of surgery was 42±11,3 min. To every patient one device was utilized. There were no replacements of OW for wrong sizing or other reasons. In 5 patients (anatomy as “chicken wing”) under angles 90-135º there was protrusion of lower border of OW found by 1/3 of the length. In patients with LAA OW sizes 33 and 27, there was residual flow registered under the lower border, of5 mmand2 mmdiameter, respectively. There were no complications during operation and nearest post-operation period. In 12 months after the study there was not dislocation, embolization or position changes among the devices. The residual flow diameter in33 mmimplant patient decreased in 6 months from 5 to2 mm, in the other — remained2 mm. No patients had brain circulation disorders and other embolies.

Conclusion. The method of OW implanting into LA of non-rheumatic origin is effective method of embolic complications prevention, not followed by bleedings and making to prognosis improvement of this kind of patients, as to quit entire life anticoagulation

1. Beinart R, Heist EK, Mansour M, et al. Left Atrial Appendage Dimensions Predict the Rick of Stroke / TIA in Patients With Atrial Fibrillation. J Cardiovasc Electrophysiol 2010; 22(1): 10-15.

2. Reddy VY, Holmes D, Kar S, et al. Safety of percutaneous left atrial appendage closure: results fromthi 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.

3. Holmes DR, Reddy VY, Sick P, et al. PROTECT AF Investigators. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of store in patients with atrial fibrillation:a randomized non-inferiority trial. Lancet 2009; 374: 534-42.

4. Holmes DR, Kar S, Price MJ, 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.

5. Chao TF, Lin YJ, Tsao HM, et al. CHA2 DS2 and CHA2 DS2 -VASc scores in the prediction of clinical outcomes in patients with atrial fibrillation after catheter ablation. J Am Coll Cardiol 2011; 58(23): 2380-85.

6. Kimura T, Takatsuki S, Inagawa K, et al. Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHA2 DS2 scores. Heat Rhythm 2013; 10: 921-25.

7. Puwanants BC, Klein AL, et al. Role of the CHA2 DS2 score in the evaluation of thromboembolic risk in patients with atrial fibrillation undergoing transesophageal echocardiography before pulmonary vein isolation. J Am Coll Cardiol 2009; 54: 2032-39.