Left atrial appendage occlusion: A better alternative to anticoagulation?

Table 1 Different endocardial left atrial appendage occlusion devices[31]

Device name	Company	Design
PLAATO	Appriva Medical Inc.	Single-lobe occluder; nitinol cage; ePTFE membrane hooks
WATCHMAN	Boston Scientific	Single-lobe occluder;nitinol frame; PET membrane; hooks
ACP	St. Jude Medical	Lobe and disc (polyester mesh); nitinol mesh structure; stabilizing wires
Amulet	St. Jude Medical	Lobe and disk (polyester mesh in both); nitinol mesh structure; stabilizing wires
WaveCrest	Coherex Medical	Single-lobe occluder; nitinol frame, polyurethane foam and ePTFE membrane; retractable anchors
Occlutech LAA	Occlutech	Single-lobe occluder; nitinol wire mesh; stabilizing loops; nanomaterial covering
Sideris Patch	Custom Medical Devices	Frameless detachable latex balloon covered with polyurethane
Lambre	Lifetech	Lobe and disk; nitinol; PET membrane; distal barbs anchors
Pfm	PFM Medical	Dual disk (distal anchor, variable middle connector, proximal disk); nitinol frame
Ultrasept	Cardia	Lobe and disk; nitinol frame; Ivalon covering; distal anchors

Table 2 Summary of data for left atrial appendage occlusion

	PROTECT-AF[46]	CAP[43]	ASAP[42]	EWOLUTION[49]	ACP[50]
Patients (n)	463	460	150	1021	1047
Follow-up	4 yr	16 mo	14 mo	30 d	13 mo
CHADS-score	2.2	2.4	2.8	2.8	n.a.
CHA2DS2-Vasc score	n.a.	n.a.	4.4	4.5	4.5
Procedural success	88.00%	95.00%	94.70%	98.50%	97.30%
Procedural stroke	1.30%	0	0.70%	n.a.	0.90%
Pericardial effusion	4.80%	2.20%	1.30%	0.50%	1.20%
Device embolization	0.60%	0	1.30%	0.20%	n.a.
Major bleeding	3.50%	n.a.	n.a.	1.60%	1.50%
Long-term stroke	2.30%	1.50%	0.70%	0.30%	2.30%

AF: Atrial fibrillation; n.a.: Not applicable.

Table 3 Different aspects of left atrial appendage occlusio

Pro	Contra
Non-inferiority to oral anticoagulation	Evaluation of other atherothrombotic sources
Alternative in patients with contraindication for anticoagulation	Unknown hemodynamic impact
Cost-effective	Postprocedural medical treatment not well defined
Reduced cumulative bleeding events during follow-up	No comparison between different devices
Good results in real-world registries	Undefined impact of residual leaks