medigraphic.com
Colegio de Medicina Interna de México.

2024, Número 07

<< Anterior Siguiente >>

Med Int Mex 2024; 40 (07)


Dispositivos de oclusión de orejuela izquierda como alternativa en la prevención del accidente cerebrovascular en la fibrilación auricular

Hernández BLE, Cabello GA, Ramírez PF, Serrano RJ, Espejel GJA, Espinola ZN

Idioma: Español
Referencias bibliográficas: 41
Paginas: 434-344
Archivo PDF: 378.89 Kb.


RESUMEN

Antecedentes: La fibrilación auricular es la arritmia más frecuente, con prevalencia del 2% en la población general. Se asocia con riesgo elevado de insuficiencia cardiaca y eventos tromboembólicos, especialmente accidentes cerebrovasculares. En los pacientes con esta arritmia, la orejuela de la aurícula izquierda es el sitio principal de formación de trombos. Uno de los pilares del tratamiento de la fibrilación auricular son los anticoagulantes, pero en los pacientes en quienes están contraindicados, los dispositivos de oclusión de orejuela izquierda son una alternativa para la prevención de accidentes cerebrovasculares. En la actualidad existen diferentes dispositivos de oclusión con varios diseños que se adaptan a la anatomía de la orejuela izquierda de cada paciente.
Caso clínico: Paciente femenina de 96 años, con antecedentes de fibrilación auricular e infarto agudo de miocardio a quien se colocó exitosamente un dispositivo de oclusión transcatéter de la orejuela izquierda.
Conclusiones: Los dispositivos de oclusión transcatéter de la orejuela izquierda son una alternativa viable y segura para la prevención de accidentes cerebrovasculares.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Gómez-Doblas JJ, López-Garrido MA, Esteve-Ruiz I, Barón-Esquivias G. Epidemiología de la fibrilación auricular. RevEsp Cardiol 2016; 16: 2-7. DOI: https://doi.org/10.1016/S1131-3587(12)70045-6

  2. Magdi M, Renjithal SLM, Mubasher M, Mostafa MR, et al.The WATCHMAN device and post-implantation anticoagulationmanagement. A review of key studies and the riskof device-related thrombosis. Am J Cardiovasc Dis 2021;11 (6): 714-22.

  3. Price MJ, Slotwiner D, Du C, Freeman JV, et al. Clinicaloutcomes at 1 year following transcatheter left atrial appendageocclusion in the United States. JACC CardiovascInterv 2022; 15 (7): 741-50. doi: 10.1016/j.jcin.2022.02.009

  4. Chung MK, Refaat M, Shen WK, Kutyifa V, et al. Atrialfibrillation. J Am Coll Cardiol 2020; 75 (14): 1689-713. doi:10.1016/j.jacc.2020.02.025

  5. Rashid HN, Layland J. Modification of the left atrial appendageand its role in stroke risk reduction with non-valvularatrial fibrillation. Int J Cardiol Heart Vasc 2021; 32: 100688.doi: 10.1016/j.ijcha.2020.100688

  6. Sommerauer C, Schlender L, Krause M, Weißbach S, et al.Effectiveness and safety of vitamin K antagonists and newanticoagulants in the prevention of thromboembolismin atrial fibrillation in older adults – a systematic reviewof reviews and the development of recommendations toreduce inappropriate prescribing. BMC Geriatr 2017; 17(S1): 223. doi: 10.1186/s12877-017-0573-6

  7. Majule DN, Jing C, Rutahoile WM, Shonyela FS. The efficacyand safety of the WATCHMAN device in LAA occlusion inpatients with non-valvular atrial fibrillation contraindicatedto oral anticoagulation: A focused review. Ann ThoracCardiovasc Surg 2018; 24 (6): 271-8. doi: 10.5761/atcs.ra.18-00014

  8. Ellis CR, Jackson GG. When to refer patients for left atrialappendage closure. Card Electrophysiol Clin 2020; 12 (1):29-37. doi: 10.1016/j.ccep.2019.11.005

  9. Morino Y, Nakajima Y. Structural heart intervention forprevention of embolic and hemorrhagic stroke: The newfield of neurocardiology. J Cardiol 2020; 76 (3): 227-35.https://doi.org/10.1016/j.jjcc.2020.04.007

  10. Pacha HM, Al-khadra Y, Soud M, Darmoch F, PachaAM, Alraies MC. Percutaneous devices for left atrialappendage occlusion: A contemporary review. World JCardiol 2019; 11 (2): 57-70. https://doi.org/10.1016/j.jjcc.2020.04.007

  11. Mostafa MR, Magdi M, Al‐abdouh A, Abusnina W, et al.A systematic review and meta‐analysis of the impact ofthe left atrial appendage closure on left atrial function.Clin Cardiol 2022; 45 (6): 614-21. doi: 10.1002/clc.23824

  12. De J Ramos Ramirez M, Young B, Harjai K, MascarenhasV, Vijayaraman P. Left atrial appendage occlusion: 2016. JIntervent Cardiol 2017; 30 (5): 448-56.

  13. Fernández A, Rodríguez A, Sénior JM, Aldana V, Borja H.Seguridad y eficacia a corto plazo del cierre de orejuelaizquierda con dispositivo WATCHMAN® en fibrilación auricularno valvular en pacientes con alto riesgo de sangrado.Rev Colomb Cardiol 2017; 24 (4): 369-75. DOI: 10.1016/j.rccar.2016.10.048

  14. Boersma LV, Ince H, Kische S, Pokushalov E, et al. Efficacyand safety of left atrial appendage closure with WATCHMANin patients with or without contraindication to oralanticoagulation: 1-Year follow-up outcome data of theEWOLUTION trial. Heart Rhythm 2017; 14 (9): 1302-8. doi:10.1016/j.hrthm.2017.05.038

  15. Gianni C, Della Rocca DG, Natale A, Horton RP. Interventionaltreatment for stroke prevention. Korean Circ J 2021;51 (1): 1. doi: 10.4070/kcj.2020.0416

  16. Grygier M, Olasińska-Wiśniewska A, Araszkiewicz A, TrojnarskaO, et al. The Watchman FLX – a new device for leftatrial appendage occlusion – design, potential benefits andfirst clinical experience. Adv Interv Cardiol 2017; 1: 62-6.doi: 10.5114/aic.2017.66188

  17. Cruz-González I, Trejo-Velasco B. Percutaneous left atrialappendage occlusion in the current practice. Kardiol Pol.2021; 79 (3): 255-68. doi: 10.33963/KP.15864

  18. Kar S, Doshi SK, Sadhu A, Horton R, et al. Primary outcomeevaluation of a next-generation left atrial appendage closuredevice: Results from the PINNACLE FLX trial. Circulation2021; 143 (18): 1754-62. https://doi.org/10.1161/CIRCULATIONAHA.120.050117

  19. Sharma SP, Park P, Lakkireddy D. Left atrial appendagesocclusion: current status and prospective. Korean Circ J

  20. 2018; 48 (8): 692. doi: 10.4070/kcj.2018.023120. Schnupp S, Ajmi I, Brachmann J, Mahnkopf C. Lifetech LAmbre:a new promising and novel device in the interventionalstroke prevention. Future Cardiol 2019; 15 (6): 405-10. doi:10.2217/fca-2019-0040

  21. Wang G, Kong B, Liu Y, Huang H. Long-term safety and efficacyof percutaneous left atrial appendage closure withthe LAmbre device. J Intervent Cardiol 2020; 2020: 1-6.doi: 10.1155/2020/6613683

  22. Chen S, Chun KRJ, Bordignon S, Weise FK, et al. Left atrialappendage occlusion using LAmbre Amulet and Watchmanin atrial fibrillation. J Cardiol 2019; 73 (4): 299-306. doi:10.1016/j.jjcc.2018.10.010

  23. Musat D. LARIAT Trial Updates. J Atr Fibrillation 2018; 11(1): 1806. doi: 10.4022/jafib.1806

  24. Altszuler D, Vainrib AF, Bamira DG, Benenstein RJ, et al.Left atrial occlusion device implantation: The role of theechocardiographer. Curr Cardiol Rep 2019; 21 (7): 66. doi:10.1007/s11886-019-1151-7

  25. Vainrib AF, Bamira DG, Saric M. Percutaneous left atrialappendage closure devices. Curr Cardiovasc Imaging Rep2017; 10 (12): 40. https://doi.org/10.1007/s12410-017-9437-x

  26. Tilz RR, Fink T, Bartus K, Wong T, et al. A collective Europeanexperience with left atrial appendage suture ligation usingthe LARIAT+ device. EP Eur 2020; 22 (6): 924-31. doi:10.1093/europace/euaa004

  27. Antonio-Villa NE, Espínola-Zavaleta N, Carvajal-Juárez I,Flores-Garcia AN, Alexanderson-Rosas E. Comorbid conditionsin individuals assessed by SPECT: Study of a referencecardiology center in Mexico City. J Nucl Cardiol 2019; 26(5): 1617-24. https://doi.org/10.1007/s12350-019-01737-5

  28. Glikson M, Wolff R, Hindricks G, Mandrola Jet al. EHRA/EAPCI expert consensus statement on catheter-based leftatrial appendage occlusion – an update. EuroIntervention2020; 15 (13): 1133-80.

  29. Lakkireddy D, Thaler D, Ellis CR, Swarup V, et al. Amplatzeramulet left atrial appendage occluder versus watchmandevice for stroke prophylaxis (amulet IDE): A randomized,controlled trial. Circulation 2021; 144 (19): 1543-52.https://doi.org/10.1161/CIRCULATIONAHA.121.057063

  30. Tzikas A, Shakir S, Gafoor S, Omran H, et al. Left atrial appendageocclusion for stroke prevention in atrial fibrillation:multicentre experience with the AMPLATZER CardiacPlug. EuroIntervention 2016; 11 (10): 1170-9.

  31. Asami M, the OCEAN-SHD Investigators. Computed tomographymeasurement for left atrial appendage closure.Cardiovasc Interv Ther 2022; 37 (3): 440-9. doi: 10.1007/s12928-022-00852-4

  32. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, et al. 2016ESC Guidelines for the management of atrial fibrillationdeveloped in collaboration with EACTS. Europace 2016; 18(11): 1609-78. https://doi.org/10.1093/eurheartj/ehw210

  33. Alli O, Doshi S, Kar S, Reddy V, et al. Quality of life assessmentin the randomized PROTECT AF (percutaneousclosure of the left atrial appendage versus warfarin therapyfor prevention of stroke in patients with atrial fibrillation)trial of patients at risk for stroke with nonvalvular atrialfibrillation. J Am Coll Cardiol 2013; 61 (17): 1790-8. doi:10.1016/j.jacc.2013.01.061

  34. Reddy VY, Möbius-Winkler S, Miller MA, Neuzil P, et al.Left atrial appendage closure with the Watchman devicein patients with a contraindication for oral anticoagulation.J Am Coll Cardiol 2013; 61 (25): 2551-6. doi: 10.1016/j.jacc.2013.03.035

  35. Dukkipati SR, Kar S, Holmes DR, Doshi SK, et al.Device-related thrombus after left atrial appendageclosure: incidence, predictors, and outcomes. Circulation2018; 138 (9): 874-85. doi: 10.1161/CIRCULATIONAHA.118.035090

  36. Saw J, Nielsen-Kudsk JE, Bergmann M, Daniels MJ, et al.Antithrombotic therapy and device-related thrombosisfollowing endovascular left atrial appendage closure. JACCCardiovasc Interv 2019; 12 (11): 1067-76. doi: 10.1016/j.jcin.2018.11.001

  37. Ciconte G, Conti M, Baldi M, Saviano M, et al. Thrombosison a left atrial appendage occluder device: the doubleedgedsword of stroke prevention strategies in atrialfibrillation. J Cardiovasc Med 2017; 18 (11): 920-1. DOI:10.2459/JCM.0000000000000570

  38. Lempereur M, Aminian A, Freixa X, Gafoor S, et al. Deviceassociatedthrombus formation after left atrial appendageocclusion: A systematic review of events reported with theWatchman, the Amplatzer Cardiac Plug and the Amulet.Catheter Cardiovasc Interv 2017; 90 (5): E111-21. doi:10.1002/ccd.26903

  39. Lammers J, Elenbaas T, Meijer A. Thrombus formation onan Amplatzer closure device after left atrial appendageclosure. Eur Heart J 2013; 34 (10): 741-741. doi: 10.1093/eurheartj/ehs437

  40. Gabriels JK, Liu CF. Peri-device leak after left atrial appendageocclusion: Minding the gap. J Am Coll Cardiol 2022; 8(6): 779-81.

  41. Alkhouli M, Du C, Killu A, Simard T, et al. Clinical Impact ofResidual Leaks Following Left Atrial Appendage Occlusion.JACC Clin Electrophysiol. 2022; 8 (6): 766-78. doi: 10.1016/j.jacep.2022.03.001




2020     |     www.medigraphic.com