Left atrial appendage closure with Watchman device in prevention of thromboembolic complications in patients with atrial fibrillation: First experience in Serbia

Milan A. Nedeljković; Branko Beleslin; Milorad Tešić; Bosiljka Vujisić Tešić; Vladan Vukčević; Goran Stanković; Siniša Stojković; Dejan Orlić; Tatjana Potpara; Nebojša Mujović; Milan Marinković; Olga Petrović; Marek Grygier; Alexey V. Protopopov; Vladimir Kanjuh; Milika Ašanin

doi:10.2298/VSP160205202N

Milan A. Nedeljković Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Branko Beleslin Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Milorad Tešić Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
Bosiljka Vujisić Tešić Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Vladan Vukčević Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Goran Stanković Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Siniša Stojković Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Dejan Orlić Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Tatjana Potpara Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Nebojša Mujović Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Milan Marinković Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia.
Olga Petrović Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia.
Marek Grygier Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.
Alexey V. Protopopov Invasive Cardiology Department, State Clinical Hospital, Krasnoyarsk Medical University by the Name of ProfV.F.Voino-Yasenetck, Krasnoyarsk, Russia;
Vladimir Kanjuh Serbian Academy of Sciences and Arts, Belgrade, Serbia.
Milika Ašanin Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP160205202N

Keywords: atrial fibrillation, cerebrovascular disorders, risk assessment, therapeutic occlusion, heart atria,

Abstract

Introduction. Atrial fibrillation (AF) is the major cause of stroke, particularly in older patients over 75 years of age. European Society of Cardiology guidelines recommend chronic anticoagulation therapy in patients with atrial fibrillation if CHA₂DS₂-VASc score is ≥ 1 [CHA₂DS₂-VASc score for estimating the risk of stroke in patients with non-rheumatic AF consisting of the first letters of patients condition: C – congestive heart failure; H – hypertension; A₂ – age ≥ 75 years; D – diabetes mellitus; S₂ – prior stroke, transitory ischaemic attack (TIA) or thrombolism; V – vascular disease; A – age 65–74 years; Sc – sex category]. However, a significant number of patients have a high bleeding risk, or are contraindicated for chronic oral anticoagulation, and present a group of patients in whom alternative treatment options for thromboembolic prevention are required. Transcatheter percutaneous left atrial appendage closure (LAAC) devices have been recommended in patients with contraindications for chronic anticoagulant therapy. Case report. We present our first three patients with nonvalvular AF and contraindications for chronic anticoagulant therapy who were successfully treated with implantation of LAAC Watchman device in Catheterization Laboratory of the Clinic for Cardiology, Clinical Center of Serbia in Belgrade Conclusion. Our initial results with Watchman LAAC device are promising and encouraging, providing real alternative in patients with non-valvular AF and contraindication for chronic anticoagulant therapy and high bleeding risk.

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