Published online before print April 15, 2002, doi: 10.1161/01.CIR.0000015605.30810.51
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2002;105:2217.)
© 2002 American Heart Association, Inc.
Basic Science Reports |
Percutaneous Left Atrial Appendage Occlusion (PLAATO) for Preventing Cardioembolism
First Experience in Canine Model
From the Section of Cardiac Electrophysiology, Department of Medicine and Cardiovascular Research Institute, University of California (T.N., M.D.L., E.P.G., R.J.L.), San Francisco; and Department of Pathology, Armed Forces Institute of Pathology (R.V., R.J.), Washington, DC.
Correspondence to Randall J. Lee, MD, PhD, Section of Cardiac Electrophysiology, Department of Medicine and Cardiovascular Research Institute, University of California, San Francisco, 500 Parnassus Ave, MU-434, Box 1354, San Francisco, CA 94143. E-mail lee@ medicine.ucsf.edu
Background— Atrial fibrillation is associated with a high risk for cardioembolic stroke. The left atrial appendage (LAA) is the source of the vast majority of these thromboemboli. A novel implanted device for percutaneous LAA transcatheter occlusion (PLAATO) has been designed to seal the LAA. The purpose of this study was to test the feasibility and safety of transcatheter LAA occlusion in dogs.
Methods and Results— A PLAATO implant was delivered to the LAA through a 12F transseptal catheter in 25 dogs. The PLAATO device was repositioned until occlusion was seen, or it was recaptured and replaced with a different size. LAA sealing was confirmed by intracardiac echocardiography and contrast fluoroscopy. Follow-up was performed 2 days to 6 months after implantation. After imaging assessment, dogs were euthanized and LAA was examined for device healing, migration, perforation, and any thrombosis, both grossly and histologically. The LAA was occluded in all cases. No mobile thrombi associated with the implantation were seen. Healing on the atrial-facing surface was 90% at 1 month and was complete by 3 months, which was confirmed by gross and histological examination. Light microscopic examination of brain, kidney, and spleen showed no evidence of emboli or infarct.
Conclusions— Transcatheter LAA occlusion is simple and feasible. At the follow-up study, the device remained in the LAA, with benign healing and no evidence of new thrombus or damage to surrounding structures. This new strategy may provide an alternative treatment for patients with nonvalvular atrial fibrillation who are less than optimal candidates for warfarin.
Key Words: atrial fibrillation • prevention • stroke • thrombosis
This article has been cited by other articles:
 |
|
 |
|
  R. Sutton, J. D. Fisher, C. Linde, and D. G. Benditt History of electrical therapy for the heart Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I3 - I10. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Onalan and E. Crystal Left Atrial Appendage Exclusion for Stroke Prevention in Patients With Nonrheumatic Atrial Fibrillation Stroke, February 1, 2007; 38(2): 624 - 630. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Kamohara, K. Fukamachi, Y. Ootaki, M. Akiyama, F. Cingoz, C. Ootaki, D. G. Vince, Z. B. Popovic, M. W. Kopcak Jr, R. Dessoffy, et al. Evaluation of a novel device for left atrial appendage exclusion: The second-generation atrial exclusion device. J. Thorac. Cardiovasc. Surg., August 1, 2006; 132(2): 340 - 346. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Stollberger, J. Finsterer, and B. Schneider Does Percutaneous Closure of the Left Atrial Appendage Prevent Stroke in Atrial Fibrillation? J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1500 - 1500. [Full Text] [PDF]
|
|
|
|
 |
|
 O. K. Mohrs, R. Schraeder, S. E. Petersen, D. Scherer, B. Nowak, H.-U. Kauczor, and T. Voigtlaender Percutaneous Left Atrial Appendage Transcatheter Occlusion (PLAATO): Planning and Follow-Up Using Contrast-Enhanced MRI Am. J. Roentgenol., February 1, 2006; 186(2): 361 - 364. [Full Text] [PDF]
|
|
|
|
|
|
K. Kamohara, K. Fukamachi, Y. Ootaki, M. Akiyama, F. Zahr, M. W. Kopcak Jr, R. Dessoffy, Z. B. Popovic, M. Daimon, D. M. Cosgrove, et al. A novel device for left atrial appendage exclusion J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1639 - 1644. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Ostermayer, M. Reisman, P. H. Kramer, R. V. Matthews, W. A. Gray, P. C. Block, H. Omran, A. L. Bartorelli, P. Della Bella, C. Di Mario, et al. Percutaneous Left Atrial Appendage Transcatheter Occlusion (PLAATO System) to Prevent Stroke in High-Risk Patients With Non-Rheumatic Atrial Fibrillation: Results From the International Multi-Center Feasibility Trials J. Am. Coll. Cardiol., July 5, 2005; 46(1): 9 - 14. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M R M Jongbloed, M J Schalij, K Zeppenfeld, P V Oemrawsingh, E E van der Wall, and J J Bax Clinical applications of intracardiac echocardiography in interventional procedures Heart, July 1, 2005; 91(7): 981 - 990. [Full Text] [PDF]
|
|
|
|
|
|
B. Schneider, J. Finsterer, and C. Stollberger Effects of percutaneous left atrial appendage transcatheter occlusion (PLAATO) on left atrial structure and function J. Am. Coll. Cardiol., February 15, 2005; 45(4): 634 - 635. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Stollberger, B. Schneider, and J. Finsterer Elimination of the Left Atrial Appendage To Prevent Stroke or Embolism?: Anatomic, Physiologic, and Pathophysiologic Considerations Chest, December 1, 2003; 124(6): 2356 - 2362. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. W Troughton, C. R Asher, and A. L Klein The role of echocardiography in atrial fibrillation and cardioversion Heart, December 1, 2003; 89(12): 1447 - 1454. [Full Text] [PDF]
|
|
|
|
|
|
M. n. Garcia-Fernandez, E. Perez-David, J. Quiles, J. Peralta, I. Garcia-Rojas, J. Bermejo, M. Moreno, and J. Silva Role of left atrial appendageobliteration in stroke reductionin patients with mitral valve prosthesis: A transesophageal echocardiographic study J. Am. Coll. Cardiol., October 1, 2003; 42(7): 1253 - 1258. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Halperin and M. Gomberg-Maitland Obliteration of the leftatrial appendage forprevention of thromboembolism J. Am. Coll. Cardiol., October 1, 2003; 42(7): 1259 - 1261. [Full Text] [PDF]
|
|