Left atrial appendage (LAA) closure is a rapidly emerging field in stroke prevention for patients with atrial fibrillation. Several percutaneous and surgical devices are now approved worldwide, and many more are in clinical development and being evaluated in research trials. The current most widely used endovascular devices worldwide are the WATCHMAN and Amplatzer Cardiac Plug (Amulet, 2nd generation) devices, which received CE Mark in 2005 and 2008, respectively. In addition, the WATCHMAN device recently received FDA approval in March 2015 in the United States for patients at high-risk of stroke who are suitable for warfarin, and who have appropriate rationale for non-pharmacologic stroke prevention alternative.
Results from several early pre-clinical and clinical research studies have ascertained the safety and efficacy of percutaneous LAA closure in stroke prevention, including randomized controlled trials with the WATCHMAN device that showed superiority in comparison to warfarin. Further pre-clinical and clinical research trials and data are rapidly accumulating with this and other devices. Although these initial randomized trials evaluated patients who are candidates for oral anticoagulation, the current predominant real-world application for this procedure is mostly restricted to patients who have contraindications to anticoagulation. Even this restricted indication have substantial implications on application of this procedure, since over 40% of patients with atrial fibrillation who have guideline indications for anticoagulation are not on anticoagulation because of contraindications, intolerance, or were felt to be poor candidates for anticoagulation. Broader application to patients without these restrictions is anticipated as this procedure and technology matures, and further clinical trial data becomes available.
In summary, LAA closure has evolved to become an important alternative to oral anticoagulation in patients with atrial fibrillation, and is expected to remain a dominant technology for stroke prevention with this prevalent arrhythmia.
Dr. Jacqueline Saw is an Interventional Cardiologist at Vancouver General Hospital (VGH), with joint appointment at St Paul's Hospital. She is a Clinical Associate Professor of Medicine at the University of British Columbia, and Program Director of the Interventional Cardiology Fellowship Program at VGH. She also served as the Head of VGH Cardiology Clinical Trials Research.
She was awarded Canada Scholar and the Dean's Entrance Scholarship for Natural Sciences at Simon Fraser University, where she did her undergraduate degree. She then obtained her medical doctorate at the University of Ottawa, where she graduated summa cum laude. She did her residency training in Internal Medicine and Cardiology at the University of British Columbia, and served as Chief Cardiology Fellow. She then proceeded to Interventional Cardiology fellowship training at the Cleveland Clinic, which encompassed carotid, peripheral and structural interventional training. She has been an active staff with the Division of Cardiology at VGH and joint appointment at St Paul's Hospital since 2004. She is also a physician proctor/preceptor for left atrial appendage (LAA) closure with the Amplatzer Cardiac Plug/Amulet and WATCHMAN devices.
Dr. Saw's research interests include spontaneous coronary artery dissection (SCAD), antiplatelet therapy, percutaneous coronary intervention, carotid artery stenting, peripheral intervention, LAA closure, and non-atherosclerotic coronary artery disease [including SCAD and coronary fibromuscular dysplasia (FMD) in women]. She is the principal investigator of the Canadian SCAD Study, PRYME, NACAD, SAFER-SCAD, Canadian WATCHMAN Registry, TAP-CABG, and ELAPSE studies. She has authored or co-authored over 100 publications, including scientific research studies, review articles and book chapters. She is also the editor of two textbooks on carotid artery stenting, and a textbook on LAA closure.
Left Atrial Appendage Closure
Mechanical Approaches to Stroke Prevention in Atrial Fibrillation
Editors: Saw, Jacqueline, Kar, Saibal, Price, Matthew (Eds.)
http://www.springer.com/gp/book/9783319162799
This webinar is to inform and educate interventional cardiologists and cardiac surgeons on:
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