La tunisie Medicale - 2021 ; Vol 99 ( n°05 ) : 525-530
[ 1059 times seen ]


Background. Stroke is a major complication of nonvalvular atrial fibrillation (AF). Despite its proven efficacy in stroke prevention, oral anticoagulation (OAC) is associated to a significant increase in bleeding complications. New techniques such as percutaneous left atrial appendage (LAA) closure were developed.
Aim: To evaluate immediate, mid- and long-term outcomes after percutaneous LAA closure in Tunisian patients presenting with nonvalvular AF.

Methods and Results. Nineteen patients with nonvalvular AF were prospectively enrolled for percutaneous LAA closure between February 2013 and June 2014. The Watchman device was used in all LAA closure procedures. Clinical and echocardiographic follow-up were carried-out at 1, 6, 12 months and six years in all patients. Mean age was 68.4 ± 7.5 years. Thirteen patients were female, 16 had hypertension, 12 had diabetes mellitus and seven had a history of stroke or transient ischemic attack (TIA). Average CHA2DS2VASc (Congestive Heart Failure/Left Ventricular Dysfunction, Hypertension, Age≥75, Diabetes mellitus, Stroke/Transient Ischemic Attack/Thromboembolic event, Vascular disease,Age≥65, Sex category) score was 4.2 ± 1.5 and HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding tendency, Labile INR, Age≥65, Drugs) score was 3.5 ± 1. Ten patients had a history of severe bleeding. Procedural success was achieved in all patients. Pericardial effusion with tamponade was reported in one case. No post-procedural death was reported. Regular follow-up at 1, 6 and12 months then every year up to 6 years reported no stroke, no thromboembolic event, no Watchman device thrombosis and three cases of death caused by a respiratory problem and cancers.

Conclusion. According to this study, LAA closure with Watchman device was safe and effective in preventing stroke in patients with nonvalvular AF and contra indication to OAC.

Key - Words
  1. References 1. Gerald V Naccarelli , Helen Varker, Jay Lin, Kathy L Schulman. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol, 2009;104:1534-9. 2. A S Go, E M Hylek, K A Phillips, Y Chang, L E Henault, J V 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,2001;285:2370-5. 3. Yoko Miyasaka , Marion E Barnes, Bernard J Gersh, Stephen S Cha, Kent R Bailey, Walter P Abhayaratna,. et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation, 2006;114:119-25. 4. National Collaborating Centre for Chronic Conditions. Atrial Fibrillation: National clinical guideline for management in primary and secondary care. Royal College of Physicians (UK) 2006. Bookshelf ID: NBK51113 5. Yoko Miyasaka 1, Marion E Barnes, Bernard J Gersh, Stephen S Cha, Kent R Bailey, James B Seward,. et al. Changing Trends of Hospital Utilization in Patients After their First Episode of Atrial Fibrillation.Am J Cardiol, 2008;102: 568–572. 6. E J Benjamin, P A Wolf, R B D'Agostino, H Silbershatz, W B Kannel, D Levy. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation, 1998;98:946-52. 7. N M Al-Saady , O A Obel, A J Camm. Left atrial appendage: structure,function, and role in thromboembolism. Heart,1999;82:547-554. 8. J Shirani , J Alaeddini. Structural remodeling of the left atrial appendage inpatients with chronic non-valvular atrial fibrillation: Implications for thrombusformation, systemic embolism, and assessment by transesophagealechocardiography. Cardiovasc Pathol, 2000;9:95-101. 9. S J Connolly 1, A Laupacis, M Gent, R S Roberts, J A Cairns, C Joyner. Canadian Atrial Fibrillation Anticoagulation (CAFA) Study. J Am Coll Cardiol, 1991;18:349-55. 10. J Morley, R Marinchak, S J Rials, P Kowey. Atrial fibrillation, anticoagulation and stroke. Am J Cardiol,1996;77:38A-44A. 11. David R Holmes, Vivek Y Reddy, Zoltan G Turi, Shephal K Doshi, Horst Sievert, Maurice Buchbinder 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, 2009;374:534-42. 12. Sick PB, Schuler G, Hauptmann KE, Grube E, Yakubov S, Turi ZG. et al. Initial worldwide experience with the WATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation.J Am Coll Cardiol, 2007;49:1490-5. 13. Perrotta L, Bordignon S, Dugo D, Fürnkranz A, Konstantinou A, Ricciardi G. et al.Complications From Left Atrial Appendage Exclusion Devices. J Atr Fibrillation, 2014; 7: 1034. 14. Rebecca Brown Fountain 1, David R Holmes, Krishnaswamy Chandrasekaran, Douglas Packer, Samuel Asirvatham, Robert Van Tassel et al. The PROTECT AF (WATCHMAN Left Atrial AppendageSystem for Embolic PROTECTion in Patients with Atrial Fibrillation) trial. Am Heart J, 2006;151:956-61. 15. Oluseun Alli 1, Shepal Doshi, Saibal Kar, Vivek Reddy, Horst Sievert, Chris al. Quality of life assessment in the randomized PROTECT AF(Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapyfor Prevention of Stroke in Patients With Atrial Fibrillation) trial of patients atrisk for stroke with nonvalvular atrial fibrillation. J Am Coll Cardiol. 2013;61:1790-8. 16. Reddy VY, Doshi SK, Sievert H, Buchbinder M, Neuzil P, Huber al. Percutaneous left atrial appendage closure for strokeprophylaxis in patients with atrial fibrillation: 2.3-Year Follow-up of thePROTECT AF (Watchman Left Atrial Appendage System for EmbolicProtection in Patients with Atrial Fibrillation) Trial. Circulation, 2013;127:720-9. 17. Vivek Y Reddy 1, Shephal K Doshi, Horst Sievert, Maurice Buchbinder, Petr Neuzil, Kenneth Huber. et al. 5-Year Outcomes After Left Atrial Appendage Closure: From the PREVAIL and PROTECT AF Trials. J Am Coll Cardiol, 2017;70:2964-2975. 18. Vivek Y Reddy, David Holmes, Shephal K Doshi, Petr Neuzil, Saibal Kar. Safety of percutaneousleft atrial appendage closure: results from the Watchman Left Atrial AppendageSystem for Embolic Protection in Patients with AF (PROTECT AF) clinical trialand the Continued Access Registry. Circulation, 2011;123:417-24. 19. Vivek Y Reddy 1, Sven Möbius-Winkler, Marc A Miller, Petr Neuzil, Gerhard Schuler, Jens Wiebe. et al. Left atrial appendage closure with the Watchman device in patients with a contraindication for oral anticoagulation: the ASAP study (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology). J Am Coll Cardiol, 2013;61:2551-6.
E-mail :
Password :
Remember Me Forgot password? Sign UP
Keywords most used
treatment Child diagnosis surgery prognosis Tunisia Children Crohn’s disease Breast cancer screening Cancer epidemiology Ulcerative colitis tuberculosis prevention
Sign up to receive our newsletter
E-mail :
Stay in Touch
Join Us! !