open access

Vol 25, No 2 (2018)
Original articles - Interventional cardiology
Published online: 2017-08-24
Submitted: 2017-06-26
Accepted: 2017-08-22
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Left atrial appendage closure for “primary primary” prevention during percutaneous closure of septal defects in patients with large atria but no atrial fibrillation

Shingo Kuwata, Juliane Vierecke, Steffen Gloekler, Francesco Maisano, Bernhard Meier, Fabian Nietlispach
DOI: 10.5603/CJ.a2017.0097
·
Cardiol J 2018;25(2):179-187.

open access

Vol 25, No 2 (2018)
Original articles - Interventional cardiology
Published online: 2017-08-24
Submitted: 2017-06-26
Accepted: 2017-08-22

Abstract

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.

Abstract

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.

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Keywords

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

About this article
Title

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

Journal

Cardiology Journal

Issue

Vol 25, No 2 (2018)

Pages

179-187

Published online

2017-08-24

DOI

10.5603/CJ.a2017.0097

Bibliographic record

Cardiol J 2018;25(2):179-187.

Keywords

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

Authors

Shingo Kuwata
Juliane Vierecke
Steffen Gloekler
Francesco Maisano
Bernhard Meier
Fabian Nietlispach

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