Percutaneous devices for left atrial appendage occlusion: A contemporary review

Table 1 Comparison of left atrial appendage occlusion devices

Device	Study	Year of Introduction	Description	Approach	Approval
Atriclip Device System (Atricure)	EXCLUDE study[33]	2008	Self-closing, sterile, implantable clip, with a reusable deployment tool applied pericardially.	Epicardial	CE Mark
Tiger Paw System (Terumo Cardiovascular Systems)	Slater et al[34]	Introduced in 2009 and recalled in 2015	Implantable fastener of titanium connectors that staples the LAA tissue plus rims of silicone that seal the puncture sites.	Epicardial	Recalled
Lariat device (SentreHEART)	Bartus et al[36]; Massumi et al[37]; Dar et al[38]	2009	Multicomponent system including: transvenous and epicardial balloon catheters, magnet tipped guidewires, and suture delivery system	Epicardial and transvenous	FDA approval for soft tissue closure not LAAO CE mark
PLAATO (Appriva Medical)	Sievert et al[43]; Ostermaye et al[44]; Bayard et al[45]; Park et al[46]	Introduced in 2001and discontinued in 2007	Self-expanding nitinol cage covered with polymeric membrane (ePTFE) designed to be placed in the orifice of the LAA	Transvenous, trans-septal	Discontinued
Watchman (Boston Scientific)	Pilot study[47]; PROTECT AF study[48-50]; PREVAIL study[51,52]; CAP 1 registry[53]; CAP 2 registry[54]; EWOLUTION registry[55-57]; RELEXAO Registry[72]; ASAP study[58]; ASAP TOO study[59]	2005	Self-expanding nitinol frame structure with fixation barbs and a permeable polyester fabric that covers the atrial facing surface of the device	Transvenous, trans-septal	FDA approved and CE Mark
ACP (St. Jude Medical)	Urena et al[67]; Gloekler et al[60]; Abualsaud et al[61]; Korsholm et al[64]; Berti et al[65]; RELEXAO; Registry[72]	2008	Self-expanding distal lobe (6.5mm in length) and proximal disc (4-6mm larger than distal lobe) nitinol mesh with articulating waist	Transvenous, trans-septal	CE Mark
Amplatzer Amulet (St. Jude Medical)	Gloekler et al[60]; Abualsaud et al[61]; Landmesser et al[62]; Tzikas et al[63]; Korsholm et al[64]; Berti et al[65]; Kleinecke et al[66]; RELEXAO; Registry[72];	2013	Self-expanding distal lobe and proximal disc nitinol mesh with articulating waist, and more anchors	Transvenous, trans-septal	CE Mark

LAAO: Left atrial appendage occlusion; FDA: Food and drug administration; ACP: Amplatzer cardiac plug.

Table 2 Antithrombotic therapy regimens following left atrial appendage occlusion

Study/reference	Regimen
PROTECT AF trial[48-50]	Warfarin for 45 d followed by aspirin and clopidogrel for 6 mo, then aspirin indefinitely
PREVAIL trial[51]	Warfarin for 45 d followed by aspirin and clopidogrel for 6 mo, then aspirin indefinitely
EWOLUTION registry[56]	warfarin in 16%, NOAC in 11%, DAPT in 60%, SAPT in 7%, and no therapy in 6%
RELEXAO registry[72]	OACs in 28.8%, SAPT in 36.2%, DAPT in 23.2%, OACs plus DAPT in 4.3%, and no therapy in 7.5%.
ASAP trial[58]	DAPT for 6 mo followed by aspirin indefinitely
EHRA/EAPCI expert consensus[75]	DAPT for 1 to 6 mo followed by aspirin indefinitely

OAC: Oral anticoagulant; NOAC: Non-vitamin K oral anticoagulant; SAPT: Single antiplatelet; DAPT: Dual antiplatelet; EHRA/EAPCI: European Heart Rhythm Association/European Association of Percutaneous Cardiovascular Interventions.

Table 3 Complications related to left atrial appendage occlusion

Complication	Incidence	Treatment
Pericardial effusion/tamponade that require intervention[47,48,50,51,53,56-58,63,76]	1.2% to 5%	Pericardiocentesis
Device embolization[47,48,50,51,56-58,63,76]	0% to 3.7%	Transcatheter removal or surgery
Device related thrombus[47,56-58,63]	Up to 14%	Anticoagulation
Persistent ASD[77]	11% at 6 mo and 7% at 12 mo	Usually small no need for treatment
Cardiac perforation[51]	0% to 0.4%	surgery
Procedure related stroke[47,48,51,53,56-58,76]	0% to 1.1%	Stroke management

ASD: Atrial septal defect.