Vorhofohrverschluss – Schritt für Schritt

Thromben im linken Vorhofohr infolge von Vorhofflimmern sind die häufigste Ursache embolischer Schlaganfälle [1]. Antikoagulanzien sind eine wirksame Prophylaxe [2]. Patienten mit nicht-valvulärem Vorhofflimmern mit Kontraindikationen gegen eine Antikoagulation können von einem Vorhofohrverschluss profitieren [3].

• Literatur

• 1 Michel P, Odier C, Faouzi M. et al. The Acute STroke Registry and Analysis of Lausanne (ASTRAL). Stroke 2010; 41: 2491-2498
• 2 Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146: 857-867
• 3 Holmes Jr DR, Doshi SK, Kar S. et al. Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation: A Patient-Level Meta-Analysis. J Am Coll Cardiol 2015; 65: 2614-2623
• 4 Glikson M, Wolff R, Hindricks G. et al. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update. EuroIntervention 2020; 15: 1133-1180
• 5 Holmes DR, Reddy VY, Turi ZG. 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: 534-542
• 6 Reddy VY, Gibson DN, Kar S. et al. Post-Approval U.S. Experience With Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation. J Am Coll Cardiol 2017; 69: 253-261
• 7 Boersma LVA, Schmidt B, Betts TR. et al. Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry. Eur Heart J 2016; 37: 2465-2474
• 8 Sondergaard L, Wong Y-H, Reddy VY. et al. Propensity-Matched Comparison of Oral Anticoagulation Versus Antiplatelet Therapy After Left Atrial Appendage Closure With Watchman. JACC Cardiovasc Interv 2019; 12: 1055-1063
• 9 Reddy VY, Doshi SK, Kar S. 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
• 10 Osmancik O, Tousek P, Herman D. et al. Interventional left atrial appendage closure vs novel anticoagulation agents in patients with atrial fibrillation indicated for long-term anticoagulation (PRAGUE-17 study). Am Heart J 2017; 183: 108-114