Introduction
Oral anticoagulation (OAC) is the cornerstone of stroke prevention in
non-valvular atrial fibrillation (NVAF) when CHADS-VASC score are high
(1,2). However, contraindication for long-term OAC related to
comorbidities, personal history of bleeding or persistent risk of
bleeding remains a frequent issue in clinical practice (3). In NVAF,
thrombi typically occur in the left atrial appendage (4), and over the
last years, left atrial appendage closure (LAAC) with an occluder device
has emerged as an alternative to OAC in selected patients (5,6).
Different design and generations of devices are available for
percutaneous LAA closure: Watchman devices™, ACP™ and Amulet™ devices,
WaveCrest™, and LAmbre™ (7).
Recently, combined strategy of concomitant LAAC for stroke prevention
and catheter ablation (CA) for AF was proposed, and an international
multicenter registry support the feasibility and safety of this strategy
(8,9). The combined strategy of concomitant CA and LAAC procedures in
symptomatic AF patients with high risk of stroke and bleeding may be a
cost-effective therapeutic option compared with CA and long term
standard oral anticoagulation (OAC) (10). Moreover, in patients with
both NVAF and patent foramen oval (PFO) or atrial septal defect (ASD),
LAAC combined with PFO or ASD closure was previously reported (11,12).
Finally, other percutaneous procedures such as leadless intracardiac
transcatheter pacing systems implantation or transcatheter edge-to-edge
mitral valve repair (TEMVR) may be combined with LAAC (13-16). Recent
publication have shown the possibility to associate safely LAAC using
AmplatzerTM devices with structural, coronary, or
electrophysiological concomitant procedures (16). Combined approach
could thus allow to treat several cardiac conditions in a single
intervention.
Here, we report our single center experience of a combined strategy with
LAAC procedure using the WatchmanTM (WN) devices and
other percutaneous procedures.