Möbius-Winkler S, Majunke N, Sandri M, Mangner N, Linke A, Stone GW, Dähnert I, Schuler G, Sick PB. Percutaneous left atrial appendage closure: Technical aspects and prevention of periprocedural complications with the watchman device. World J Cardiol 2015; 7(2): 65-75 [PMID: 25717354 DOI: 10.4330/wjc.v7.i2.65]
Corresponding Author of This Article
Peter B Sick, MD, Clinic for Cardiology, Hospital Barmherzige Brueder, Pruefeningerstrasse 86, 93049 Regensburg, Germany. peter.sick@barmherzige-regensburg.de
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Feb 26, 2015; 7(2): 65-75 Published online Feb 26, 2015. doi: 10.4330/wjc.v7.i2.65
Percutaneous left atrial appendage closure: Technical aspects and prevention of periprocedural complications with the watchman device
Sven Möbius-Winkler, Nicolas Majunke, Marcus Sandri, Norman Mangner, Axel Linke, Gregg W Stone, Ingo Dähnert, Gerhard Schuler, Peter B Sick
Sven Möbius-Winkler, Nicolas Majunke, Marcus Sandri, Norman Mangner, Axel Linke, Gerhard Schuler, Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, 04251 Leipzig, Germany
Gregg W Stone, Columbia University Medical Center, New York, NY 10032, United States
Ingo Dähnert, Department of Pediatric Cardiology, University of Leipzig, Heart Center, 04251 Leipzig, Germany
Peter B Sick, Clinic for Cardiology, Hospital Barmherzige Brueder, 93049 Regensburg, Germany
Author contributions: All authors had contributed to the manuscript by their personal experience in terms of interventional or echocardiographic speciality by discussing the topics mentioned in the manuscript; Möbius-Winkler S and Majunke N was primarily written this manuscript; Möbius-Winkler S, Majunke N contributing equally, and completely reviewed by Schuler G and Sick PB as the world wide pioneers with this system as well as Linke A and Sandri M due to their high experience with the Watchman procedures; Stone GW reviewed the paper as a native speaker and highly sophisticated interventionalist in the United States; Mangner N and Dähnert I supported the review of the manuscript by their high experience in echocardiography, accompanying most of the procedures at the Heart Center Leipzig.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Peter B Sick, MD, Clinic for Cardiology, Hospital Barmherzige Brueder, Pruefeningerstrasse 86, 93049 Regensburg, Germany. peter.sick@barmherzige-regensburg.de
Telephone: +49-941-3692101 Fax: +49-941-3692107
Received: September 9, 2014 Peer-review started: September 10, 2014 First decision: October 14, 2014 Revised: October 26, 2014 Accepted: November 7, 2014 Article in press: November 10, 2014 Published online: February 26, 2015
Abstract
Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients with contraindications to chronic oral anticoagulation. The promise of this new intervention compared with warfarin has been supported by several, small studies and two pivotal randomized trial with the Watchman Device. The results regarding risk reduction for stroke have been favourable although acute complications were not infrequent. Procedural complications, which are mainly related to transseptal puncture and device implantation, include air embolism, pericardial effusions/tamponade and device embolization. Knowledge of nature, management and prevention of complications should minimize the risk of complications and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke.
Core tip: Left atrial appendage (LAA)-Occlusion was developed as an alternative to chronic anticoagulation therapy in patients with nonvalvular atrial fibrillation. In two large randomized trials the principal concept of LAA-occlusion has been demonstrated to be noninferior to coumadine therapy, in longterm follow up being even superior to oral anticoagulation in terms of efficacy and some safety issues like bleeding complications. However the procedure is complex and knowledge of nature, management and prevention of complications should minimize the risk of the procedure and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke.
