Left atrial appendage closure for primary primary prevention during percutaneous closure of septal defects in patients with large atria but no atrial fibrillation.

Kuwata, Shingo; Vierecke, Juliane; Gloekler, Steffen; Maisano, Francesco; Meier, Bernhard; Nietlispach, Fabian (2018). Left atrial appendage closure for primary primary prevention during percutaneous closure of septal defects in patients with large atria but no atrial fibrillation. Cardiology journal, 25(2), pp. 179-187. Via Medica 10.5603/CJ.a2017.0097

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BACKGROUND Percutaneous atrial septal defect (ASD) closure is a routine procedure to prevent right ventricular failure, pulmonary hypertension, or paradoxical embolism. The latter is the typical reason for percutaneous patent foramen ovale (PFO) closure. Atrial enlargement represents a risk for developing atrial fibrillation (AF). Percutaneous left atrial appendage (LAA) closure is emerging as a preventive therapy for patients in AF who suffered from a previous stroke or bleeding (secondary prevention) or patients without previous stroke or bleeding (primary prevention). Percutaneous septal closure, particularly that of large ASDs, may inhibit future percutaneous left atrial access when required for LAA closure. Reported herein is the feasibility and safety of concomitant percutaneous closure of the LAA and a septal shunt, mostly large ASDs, in patients without AF, in the sense of primary primary preventive LAA closure. The first "primary" relates to "in anticipation of AF" and potentially also for "for prevention of AF". The second "primary" relates to "prevention of stroke or bleeding". METHODS Thirteen consecutive patients, older than 40 years without any clinical or electrocardiographic evidence of AF, underwent percutaneous closure of large ASDs or PFOs in the presence of enlarged atria at the university hospitals of Bern and Zurich between April 2013 and June 2015. They concomitantly received primary primary preventive LAA closure after informed consent. RESULTS Mean patient age was 58 ± 9 years (46% male). Procedural success was achieved in all patients and no major adverse events occurred acutely or during the following 2.0 ± 0.8 years. No patient developed AF. CONCLUSIONS Concomitant closure of ASD or PFO in the presence of enlarged atria and LAA for primary primary prevention appears feasible and safe but has yet to prove its justification.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Meier, Bernhard

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1897-5593

Publisher:

Via Medica

Language:

English

Submitter:

Luana Cauto

Date Deposited:

26 Feb 2018 16:10

Last Modified:

05 Nov 2019 04:12

Publisher DOI:

10.5603/CJ.a2017.0097

PubMed ID:

28840592

Uncontrolled Keywords:

atrial fibrillation atrial septal defect closure left atrial appendage closure patent foramen ovale closure

BORIS DOI:

10.7892/boris.111202

URI:

https://boris.unibe.ch/id/eprint/111202

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