Mechanical antithrombotic intervention by LAA occlusion in atrial fibrillation

Nature Reviews Cardiology

Volumn 10, Issue 12, 2013, Pages 707-722

  Yu, Cheuk Man ^a   Khattab, Ahmed A ^b   Bertog, Stefan C ^c   Lee, Alex P W ^a   Kwong, Joey S W ^a   Sievert, Horst ^c   Meier, Bernhard ^b  

^a CHINESE UNIVERSITY OF HONG KONG   (Hong Kong)

^b BERN UNIVERSITY HOSPITAL   (Switzerland)

^c Cardiovascular Centre Frankfurt   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLSALICYLIC ACID; ANTICOAGULANT AGENT; APIXABAN; CLOPIDOGREL; DABIGATRAN; RIVAROXABAN; WARFARIN;

AMPLATZER CARDIAC PLUG; ANGIOGRAPHY; ANTICOAGULANT THERAPY; BALLOON CATHETER; BLEEDING; BLOOD CLOTTING; BRAIN HEMORRHAGE; CANNULA; CEREBROVASCULAR ACCIDENT; COMPUTER ASSISTED TOMOGRAPHY; DEVICE ASSOCIATED THROMBUS; DEVICE EMBOLISM; DRUG EFFICACY; DRUG MONITORING; DRUG SAFETY; DRUG WITHDRAWAL; EMBOLISM; FLUOROSCOPY; GUIDE WIRE; HEART ATRIUM FIBRILLATION; HEART TAMPONADE; HUMAN; INTRACARDIAC ECHOCARDIOGRAPHY; INTRACARDIAC THROMBOSIS; LEFT ATRIAL APPENDAGE OCCLUDER; MEDICAL DEVICE; MORBIDITY; MORTALITY; NONHUMAN; OCCLUSION DEVICE; PATIENT SAFETY; PATIENT SELECTION; PERCUTANEOUS CORONARY INTERVENTION; PERCUTANEOUS TRANSCATHETER MECHANICAL OCCLUSION OF THE LEFT APPENDAGE; PERICARDIAL EFFUSION; PERICARDIAL GUIDE CANNULA; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; RISK ASSESSMENT; SUTURE DELIVERY DEVICE; THROMBOEMBOLISM; THROMBUS; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; TRANSTHORACIC ECHOCARDIOGRAPHY; VASCULAR DISEASE;

ANIMALS; ATRIAL APPENDAGE; ATRIAL FIBRILLATION; CARDIAC CATHETERIZATION; DIAGNOSTIC IMAGING; EQUIPMENT DESIGN; HEALTH CARE COSTS; HUMANS; PATIENT SELECTION; PREDICTIVE VALUE OF TESTS; STROKE; THROMBOSIS; TREATMENT OUTCOME;

EID: 84888642926     PISSN: 17595002     EISSN: 17595010     Source Type: Journal    
DOI: 10.1038/nrcardio.2013.158     Document Type: Review

References (102)

1. Hart, R. G. et al. Lessons from the stroke prevention in atrial fibrillation trials. Ann. Intern. Med. 138, 831-838 (2003
2. Go, A. S. et al. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285, 2370-2375 (2001
3. Camm, A. J. et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Eur. Heart J. 33, 2719-2747 (2012
4. Kirchhof, P. et al. Outcome parameters for trials in atrial fibrillation: Executive summary. Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eur. Heart J. 28, 2803-2817 (2007
5. Knecht, S. et al. Atrial fibrillation in stroke-free patients is associated with memory impairment and hippocampal atrophy. Eur. Heart J. 29, 2125-2132 (2008
6. Kempster, P. A., Gerraty, R. P. & Gates, P. C. Asymptomatic cerebral infarction in patients with chronic atrial fibrillation. Stroke 19, 955-957 (1988
7. Stroke Prevention in Atrial Fibrillation Investigators. Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation 84, 527-539 (1991
8. Friberg, L., Hammar, N. & Rosenqvist, M. Stroke in paroxysmal atrial fibrillation: Report from the Stockholm Cohort of Atrial Fibrillation. Eur. Heart J. 31, 967-975 (2010
9. Gage, B. F. et al. Validation of clinical classification schemes for predicting stroke: Results from the National Registry of Atrial Fibrillation. JAMA 285, 2864-2870 (2001
10. Lip, G. Y., Nieuwlaat, R., Pisters, R., Lane, D. A. & Crijns, H. J. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The euro heart survey on atrial fibrillation. Chest 137, 263-272 (2010
11. Hart, R. G., Pearce, L. A. & Aguilar, M. I. Meta-Analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann. Intern. Med. 146, 857-867 (2007
12. Bungard, T. J., Ghali, W. A., Teo, K. K., McAlister, F. A. & Tsuyuki, R. T. Why do patients with atrial fibrillation not receive warfarin? Arch. Intern. Med. 160, 41-46 (2000
13. Landefeld, C. S. & Beyth, R. J. Anticoagulant-related bleeding: Clinical epidemiology, prediction, and prevention. Am. J. Med. 95, 315-328 (1993
14. Kwong, J. S., Lam, Y. Y., Yan, B. P. & Yu, C. M. Bleeding of new oral anticoagulants for stroke prevention in atrial fibrillation: A meta-Analysis of randomized controlled trials. Cardiovasc. Drugs Ther. 27, 23-35 (2013
15. Granger, C. B. et al. Apixaban versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 365, 981-992 (2011
16. Connolly, S. J. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 361, 1139-1151 (2009
17. Patel, M. R. et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N. Engl. J. Med. 365, 883-891 (2011
18. Heidbuchel, H. et al. European Heart Rhythm Association practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 15, 625-651 (2013
19. Al-Saady, N. M., Obel, O. A. & Camm, A. J. Left atrial appendage: Structure, function, and role in thromboembolism. Heart 82, 547-554 (1999
20. Veinot, J. P. et al. Anatomy of the normal left atrial appendage: A quantitative study of age-related changes in 500 autopsy hearts: Implications for echocardiographic examination. Circulation 96, 3112-3115 (1997
21. Sharma, S., Devine, W., Anderson, R. H. & Zuberbuhler, J. R. The determination of atrial arrangement by examination of appendage morphology in 1,842 heart specimens. Br. Heart J. 60, 227-231 (1988
22. Mügge, A. et al. Assessment of left atrial appendage function by biplane transesophageal echocardiography in patients with nonrheumatic atrial fibrillation: Identification of a subgroup of patients at increased embolic risk. J. Am. Coll. Cardiol. 23, 599-607 (1994
23. Pollick, C. & Taylor, D. Assessment of left atrial appendage function by transesophageal echocardiography. Implications for the development of thrombus. Circulation 84, 223-231 (1991
24. Shirani, J. & Alaeddini, J. Structural remodeling of the left atrial appendage in patients with chronic non-valvular atrial fibrillation: Implications for thrombus formation, systemic embolism, and assessment by transesophageal echocardiography. Cardiovasc. Pathol. 9, 95-101 (2000
25. Manning, W. J., Silverman, D. I., Keighley, C. S., Oettgen, P. & Douglas, P. S. Transesophageal echocardiographically facilitated early cardioversion from atrial fibrillation using short-Term anticoagulation: Final results of a prospective 4.5-year study. J. Am. Coll. Cardiol. 25, 1354-1361 (1995
26. Blackshear, J. L. & Odell, J. A. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann. Thorac. Surg. 61, 755-759 (1996
27. Nakai, T. et al. Percutaneous left atrial appendage occlusion (PLAATO) for preventing cardioembolism: First experience in canine model. Circulation 105, 2217-2222 (2002
28. Sievert, H. et al. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: Early clinical experience. Circulation 105, 1887-1889 (2002
29. Hanna, I. R. et al. Left atrial structure and function after percutaneous left atrial appendage transcatheter occlusion (PLAATO): Six-month echocardiographic follow-up. J. Am. Coll. Cardiol. 43, 1868-1872 (2004
30. Ostermayer, S. H. 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. 46, 9-14 (2005
31. Block, P. C. et al. Percutaneous left atrial appendage occlusion for patients in atrial fibrillation suboptimal for warfarin therapy: 5 year results of the PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) Study. JACC Cardiovasc. Interv. 2, 594-600 (2009
32. Bayard, Y. L. et al. PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) for prevention of cardioembolic stroke in non-Anticoagulation eligible atrial fibrillation patients: Results from the European PLAATO study. EuroIntervention 6, 220-226 (2010
33. Schmid, M., Khattab, A. A., Gloekler, S. & Meier, B. Future epidemic impact of atrial fibrillation and a new interventional strategy for stroke prophylaxis. Future Cardiol. 7, 219-226 (2011
34. Meier, B. Catheter-based atrial shunt occlusion, when the going gets even thougher. Catheter. Cardiovasc. Interv. 69, 21-22 (2007
35. Guérios, E. E. et al. Left atrial appendage closure with the Amplatzer cardiac plug in patients with atrial fibrillation. Arq. Bras. Cardiol. 98, 528-536 (2012
36. Freixa, X. et al. The Amplatzer™ Cardiac Plug 2 for left atrial appendage occlusion: Novel features and first in man experience. EuroIntervention 8, 1094-1098 (2013
37. Holmes, D. R. et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: A randomised non-inferiority trial. Lancet 374, 534-542 (2009
38. Reddy, V. Y. et al. left atrial appendage closure with the watchman device in patients with a contraindication for oral anticoagulation: ASA-Plavix feasibility study with watchman left atrial appendage closure technology (ASAP Study). J. Am. Coll. Cardiol. 61, 2551-2556 (2013
39. Hildick-Smith, D. J. R. et al. AMPLATZER device closure of atrial septal defects in mature adults: Analysis of 76 cases. Heart 90, 334-335 (2004
40. Meier, B. et al. Transcatheter left atrial appendage occlusion with AMPLATZER devices to obviate anticoagulation in patients with atrial fibrillation. Catheter. Cardiovasc. Interv. 60, 417-422 (2003
41. Sievert, H. et al. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: Early clinical experience. Circulation 105, 1887-1889 (2002
42. Schmid, M. et al. Transcatheter left atrial appendage closure in patients with atrial fibrillation: Comparison between non-dedicated and dedicated Amplatzer devices. Cardiovasc. Med. 16, 123-130 (2013
43. Santoro, G The next step on the learning curve: First publication and acute data-results of the Italian registry. Presented at the XIV International Symposium on Progress In Clinical Pacing (2010
44. Park, J. W. et al. Dual center experience with different strategies of left atrial appendage closure with AMPLATZER Cardiac Plug for prevention of stroke in atrial fibrillation. Int. J. Cardiol. 147 (Suppl. 1), S2-S3 (2011
45. Park, J. W. et al. Acute safety results from ACP European multicenter post-market observational study. EuroIntervention 8 (Suppl. N.), 314 (2012
46. Park, J W. Results of the AMPLATZER Cardiac Plug European Multicenter Observational Study. Presented at the Transcatheter Cardiovascular Therapeutics Conference 2012
47. Lopez-Minguez, J. R. et al. Immediate and one-year results in 35 consecutive patients after closure of left atrial appendage with the AMPLATZER Cardiac Plug. Rev. Esp. Cardiol. 66, 90-97 (2013
48. Park, J. W. et al. Left atrial appendage closure with AMPLATZER cardiac plug in atrial fibrillation: Initial European experience. Catheter. Cardiovasc. Interv. 77, 700-706 (2011
49. Gloekler, S. et al. Transcatheter left atrial appendage occlusion in atrial fibrillation: A 100 cases single center experience. EuroIntervention 8 (Suppl. N.), 311 (2012
50. Lam, Y. Y. et al. Left atrial appendage closure with AMPLATZER Cardiac Plug for stroke prevention in atrial fibrillation: Initial Asia-Pacific experience. Catheter. Cardiovasc. Interv. 79, 794-800 (2012
51. Kefer, J. et al. Transcatheter percutaneous left atrial appendage closure for stroke prevention in atrial fibrillation: The Belgian Registry. Presented at EuroPCR 2013
52. Reddy, V. Y. et al. Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3-year follow-up of the PROTECT-AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) Trial. Circulation 127, 720-729 (2013
53. Reddy, V Y. et al. Long term results of PROTECT-AF: The mortality effects of left atrial appendage closure versus warfarin for stroke prophylaxis in AF. Presented at the Heart Rhythm Society Annual Scientific Sessions 2013
54. Lee, R. J., Bartus, K. & Yakubov, S. J. Catheter-based left atrial appendage (LAA) ligation for the prevention of embolic events arising from the LAA: Initial experience in a canine model. Circ. Cardiovasc. Interv. 3, 224-229 (2010
55. Singh, S. M., Dukkipati, S. R., d'Avila, A., Doshi, S. K. & Reddy, V. Y. Percutaneous left atrial appendage closure with an epicardial suture ligation approach: A prospective randomized pre-clinical feasibility study. Heart Rhythm 7, 370-376 (2010
56. Bartus, K. et al. Feasibility of closed-chest ligation of the left atrial appendage in humans. Heart Rhythm 8, 188-193 (2011
57. Bartus, K. et al. Percutaneous left atrial appendage suture ligation using the LARIAT device in patients with atrial fibrillation: Initial clinical experience. J. Am. Coll. Cardiol. 62, 108-118 (2013
58. Holmes, D R. Jr. Randomized trial of LAA closure vs warfarin for stroke/ thromboembolic prevention in patients with non-valvular atrial fibrillation (PREVAIL). Presented at the ACC Scientific Sessions 2013
59. Reddy, V. Y., Holmes, D., Doshi, S. K., Neuzil, P. & Kar, S. Safety of percutaneous left atrial appendage closure: Results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT-AF) clinical trial and the Continued Access Registry. Circulation 123, 417-424 (2011
60. Sick, P. B. et al. Initial worldwide experience with the WATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation. J. Am. Coll. Cardiol. 49, 1490-1495 (2007
61. Sick, P et al. Stroke prevention in non-valvular atrial fibrillation: Long-Term results after 6 years of the Watchman Left Atrial Appendage Occlusion Pilot Study. Presented at the ESC Congress 2012
62. Sideris, E., Toumanides, S., Stylianos, R., Macuil, B. & Moulopoulos, S. Transcatheter patch obliteration of the left atrial appendage: Experimental validation and early clinical experience. J. Am. Coll. Cardiol. 47, 1B (2006
63. Toumanides, S., Sideris, E. B., Agricola, T. & Moulopoulos, S. Transcatheter patch occlusion of the left atrial appendage using surgical adhesives in high-risk patients with atrial fibrillation. J. Am. Coll. Cardiol. 58, 2236-2240 (2011
64. Cheng, Y et al. Safety and biocompatibility of the Coherex WaveCrest™ left atrial appendage occluder in a 30-day canine study. Presented at the Transcatheter Cardiovascular Therapeutics Conference 2012
65. Belcher, J. R. & Somerville, W. Systemic embolism and left auricular thrombosis in relation to mitral valvotomy. BMJ 2, 1000-1003 (1955
66. Blackshear, J. L. & Odell, J. A. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann. Thorac. Surg. 61, 755-759 (1996
67. Bonow, R. O. et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Valvular Heart Disease. J. Am. Coll. Cardiol. 52, e1-e142 (2008
68. Johnson, W. D., Ganjoo, A. K., Stone, C. D., Srivyas, R. C. & Howard, M. The left atrial appendage: Our most lethal human attachment! Surgical implications. Eur. J. Cardiothorac. Surg. 17, 718-722 (2000
69. Healey, J. S. et al. Left Atrial Appendage Occlusion Study (LAAOS): Results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke. Am. Heart J. 150, 288-293 (2005
70. Katz, E. S. et al. Surgical left atrial appendage ligation is frequently incomplete: A transesophageal echocardiograhic study. J. Am. Coll. Cardiol. 36, 468-471 (2000
71. Kanderian, A. S., Gillinov, A. M., Pettersson, G. B., Blackstone, E. & Klein, A. L. Success of surgical left atrial appendage closure: Assessment by transesophageal echocardiography. J. Am. Coll. Cardiol. 52, 924-929 (2008
72. Swaans, M., Post, M. C., Rensing, B. J. & Boersma, L. V. Ablation for atrial fibrillation in combination with left atrial appendage closure: First results of a feasibility study. J. Am. Heart Assoc. 1, e002212 (2012
73. Romero, J. et al. Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: A meta-Analysis. Circ. Cardiovasc. Imaging 6, 185-194 (2013
74. Poulter, R. S. et al. Cardiac computed tomography follow-up of left atrial appendage exclusion using the AMPLATZER Cardiac Plug device. Can. J. Cardiol. 28, 119.e1-119.e3 (2012
75. Chue, C. D., de Giovanni, J. & Steeds, R. P. The role of echocardiography in percutaneous left atrial appendage occlusion. Eur. J. Echocardiogr. 12, i3-i10 (2011
76. Perk, G. et al. Catheter-based left atrial appendage occlusion procedure: Role of echocardiography. Eur. Heart J. Cardiovasc. Imaging 13, 132-138 (2012
77. Jorgensen, J. et al. Implantation of left atrial appendage occlusion devices and complex appendage anatomy: The importance of transesophageal echocardiography. Echocardiography 24, 159-161 (2007
78. Agmon, Y., Khandheria, B., Gentile, F. & Seward, J. Echocardiographic assessment of the left atrial appendage. J. Am. Coll. Cardiol. 34, 1867-1877 (1999
79. Lockwood, S. M., Alison, J. F., Obeyesekere, M. N. & Mottram, P. M. Imaging the left atrial appendage prior to, during, and after occlusion. JACC Cardiovasc. Imaging 4, 303-306 (2011
80. Marek, D., Vindis, D. & Kocianova, E. Real time 3 dimensional transesophageal echocardiography is more specific than 2 dimensional TEE in the assessment of left atrial appendage thrombosis. Biomed. Pap. Med. Fac. Univ. Palacky Olomouc Czech. Repub. 157, 22-26 (2013
81. Chan, S. K., Kannam, J. P., Douglas, P. S. & Manning, W. J. Multiplane transesophageal echocardiographic assessment of left atrial appendage anatomy and function. Am. J. Cardiol. 76, 528-530 (1995
82. Nucifora, G. et al. Evaluation of the left atrial appendage with real-Time 3 dimensional transesophageal echocardiography: Implications for catheter-based left atrial appendage closure. Circ. Cardiovasc. Imaging 4, 514-523 (2011
83. Nakajima, H. et al. Analysis of the left atrial appendage by three-dimensional transesophageal echocardiography. Am. J. Cardiol. 106, 885-892 (2010
84. Unsworth, B., Sutaria, N., Davies, D. W. & Kanagaratnam, P. Successful placement of left atrial appendage closure device is heavily dependent on 3 dimensional transesophageal imaging. J. Am. Coll. Cardiol. 58, 1283 (2011
85. Shah, S. J. et al. Real-Time three-dimensional transesophageal echocardiography of the left atrial appendage: Initial experience in the clinical setting. J. Am. Soc. Echocardiogr. 21, 1362-1368 (2008
86. Silvestry, F. E. et al. Echocardiography-guided interventions. J. Am. Soc. Echocardiogr. 22, 213-231 (2009
87. Lee, A. P. et al. Role of real time three-dimensional transesophageal echocardiography in guidance of interventional procedures in cardiology. Heart 96, 1485-1493 (2010
88. Main, M. L., Latus, G. G., Magalski, A. & Huber, K. C. Contrast enhanced transesophageal echocardiographic guidance of left atrial appendage closure device implantation. J. Am. Soc. Echocardiogr. 23, 1007.e3-1007.e4 (2010
89. Su, P., McCarthy, K. P. & Ho, S. Y. Occluding the left atrial appendage: Anatomical considerations. Heart 94, 1166-1170 (2008
90. Cruz-Gonzalez, I., Martín Moreiras, J. & García, E. Thrombus formation after left atrial appendage exclusion using an Amplatzer cardiac plug device. Catheter. Cardiovasc. Interv. 78, 970-973 (2011
91. Gasparini, M., Ceriotti, C. & Bragato, R. Huge left atrial thrombus after left atrial appendage occlusion with a Watchman device. Eur. Heart J. 33, 1998 (2012
92. Bai, R. et al. Intraprocedural and long-Term incomplete occlusion of the left atrial appendage following placement of the WATCHMAN device: A single center experience. J. Cardiovasc. Electrophysiol. 23, 455-461 (2012
93. Viles-Gonzalez, J. F. et al. The clinical impact of incomplete left atrial appendage closure with the Watchman device in patients with atrial fibrillation: A PROTECT-AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation) substudy. J. Am. Coll. Cardiol. 59, 923-929 (2012
94. Viles-Gonzalez, J. F. et al. Incomplete occlusion of the left atrial appendage with the percutaneous left atrial appendage transcatheter occlusion device is not associated with increased risk of stroke. J. Interv. Card. Electrophysiol. 33, 69-75 (2012
95. Singh, S. M., Douglas, P. S. & Reddy, V. Y. The incidence and long-Term clinical outcome of iatrogenic atrial septal defects secondary to transseptal catheterization with a 12F transseptal sheath. Circ. Arrhythm. Electrophysiol. 4, 166-171 (2011
96. Blendea, D. et al. Analysis of the left atrial appendage morphology by intracardiac echocardiography in patients with atrial fibrillation. J. Interv. Card. Electrophysiol. 31, 191-196 (2011
97. Saksena, S. et al. A prospective comparison of cardiac imaging using intracardiac echocardiography with transesophageal echocardiography in patients with atrial fibrillation: The intracardiac echocardiography guided cardioversion helps interventional procedures study. Circ. Arrhythm. Electrophysiol. 3, 571-577 (2010
98. Ren, J. F. et al. Intracardiac echocardiographic diagnosis of thrombus formation in the left atrial appendage: A complementary role to transesophageal echocardiography. Echocardiography 30, 72-80 (2013
99. Mráz, T., Neuzil, P., Mandysová, E., Niederle, P. & Reddy, V. Y. Role of echocardiography in percutaneous occlusion of the left atrial appendage. Echocardiography 24, 401-404 (2007
100. MacDonald, S. T., Newton, J. D. & Ormerod, O. J. Intracardiac echocardiography off piste? Closure of the left atrial appendage using ICE and local anesthesia. Catheter Cardiovasc. Interv. 77, 124-127 (2011
101. Meier, B., Tarbine, S. G. & Costantini, C. R. Percutaneous management of left atrial appendage perforation during device closure. Catheter. Cardiovasc. Interv. http://dx.doi.org/10.1002/ccd.24991
102. Singh, S. M., Micieli, A. & Wijeysundera, H. C. Economic evaluation of percutaneous left atrial appendage occlusion, dabigatran, and warfarin for stroke prevention in patients with nonvalvular atrial fibrillation. Circulation 127, 2414-2423 (2013