Article

Stroke, as the third cause of death in developed countries, is a
public health issue. Atrial fibrillation is an important cause of ischemic stroke
and its prevention is efficient with oral anticoagulation. However, oral
anticoagulation can be contraindicated because of hemorrhagic risk related to
these treatments. Percutaneous left atrial appendage occlusion is a new
alternative of oral anticoagulation for patients with atrial fibrillation and
high risk of cardio-embolic stroke but contraindicated for oral anticoagulation.
METHODS: We describe in this paper the procedure of left atrial appendage
occlusion with the Amplatzer cardiac plug device, used in our center in Grenoble
university hospital, for the first three patients who have been treated with this
device. These three patients (one man and two women) have all atrial fibrillation
with neurological complication of this arrhythmia, as ischemic stroke. Oral
anticoagulation is indicated to prevent another ischemic stroke. However, they
all have a high risk of cerebral bleeding for different reasons (cavernomatosis,
history of intracerebral hemorrhage and aneurysm of the polygon of Willis).
Consequently, they have a high risk of cardio-embolic complication but
contraindication for oral anticoagulation. They have been treated by left atrial
appendage occlusion with Amplatzer cardiac plug device by percutaneous and
trans-septal access. Then, they have been followed by neurologist and
cardiologist, with clinical and paraclinical evaluation by echocardiography.
RESULTS: Our three first patients have been successfully implanted, without
periprocedural complication. No latest adverse event was observed, and
particularly no cardiac or neurologic adverse event. CONCLUSION: The technique of
left atrial appendage occlusion is a very interesting and promising technique for
ischemic stroke prevention in patient with high risk of cardio-embolic
complication because of atrial fibrillation, but high risk of bleeding and
contraindication for oral anticoagulation. Because of frequency of both atrial
fibrillation and contraindication for oral anticoagulation, occlusion of the left
atrial appendage should become an interesting alternative for many patients.
However, it remains an invasive procedure and efficacy and indications need to be
evaluated in further clinical trials. Risk/benefit ratio must be carefully
assessed and compared to that of the new anticoagulant drugs.
CI - Copyright (c) 2015. Published by Elsevier Masson SAS.

Langue : ANGLAIS