循環器ジャーナル66巻2号

2018年04月発行

特集 Structural Heart Diseaseインターベンション—「新しい」インターベンションのすべて Ⅳ．新しいインターベンション

左心耳閉鎖デバイス—最新のエビデンスと今後の展望

著者： 中島祥文¹

所属機関： ¹

ページ範囲：P.288 - P.295

Point
・心原性の脳梗塞予防において，欧米でカテーテルによる左心耳閉鎖デバイスが開発され臨床応用されている．
・脳梗塞ハイリスク，出血ハイリスクの心房細動患者が同デバイス治療の対象患者になる．
・手技の成熟，術者の成熟，デバイスの改良によって，より安全確実に手技が行われるようになってきている．

参考文献

1) Inoue H, Fujiki A, Origasa H, et al:Prevalence of atrial fibrillation in the general population of Japan:an analysis based on periodic health examination. Int J Cardiol 137:102-107, 2009

2) Blackshear JL, Odell JA:Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg 61:755-759, 1996

3) Hohnloser SH, Pajitnev D, Pogue J, et al:Incidence of stroke in paroxysmal versus sustained atrial fibrillation in patients taking oral anticoagulation or combined antiplatelet therapy:an ACTIVE W Substudy. J Am Coll Cardiol 50:2156-2161, 2007

4) Martinez C, Katholing A, Wallenhorst C, Freedman SB:Therapy persistence in newly diagnosed non-valvular atrial fibrillation treated with warfarin or NOAC. A cohort study. Thromb Haemost 115:31-39, 2016

5) Gage BF, Waterman AD, Shannon W, et al:Validation of clinical classification schemes for predicting stroke:results from the National Registry of Atrial Fibrillation. JAMA 285:2864-2870, 2001

6) January CT, Wann LS, Alpert JS, et al:2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol 64:e1-76, 2014

7) Lip GY, Frison L, Halperin JL, Lane DA:Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation:the HAS-BLED（Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly）score. J Am Coll Cardiol 57:173-180, 2011

8) Reddy VY, Doshi SK, Sievert H, et al:Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation:2.3-Year Follow-up of the PROTECT AF（Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation）Trial. Circulation 127:720-729, 2013

9) Holmes DR Jr, Kar S, Price MJ, et al:Prospective randomized evaluation of the WATCHMAN left atrial appendage closure device in patients with atrial fibrillation versus long-term warfarin therapy:the PREVAIL trial. J Am Coll Cardiol 64:1-12, 2014

10) Holmes DR Jr, Kar S, Price MJ, 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 65:2614-2623, 2015

11) Boersma LV, Ince H, Kische S, et al:Efficacy and safety of left atrial appendage closure with WATCHMAN in patients with or without contraindication to oral anticoagulation:1-Year follow-up outcome data of the EWOLUTION trial. Heart Rhythm 14:1302-1308, 2017

12) Landmesser U, Schmidt B, Nielsen-Kudsk JE, et al:Left atrial appendage occlusion with the AMPLATZER Amulet device:periprocedural and early clinical/echocardiographic data from a global prospective observational study. EuroIntervention 13:867-876, 2017

13) Price MJ, Gibson DN, Yakubov SJ, et al:Early safety and efficacy of percutaneous left atrial appendage suture ligation:results from the U.S. transcatheter LAA ligation consortium. J Am Coll Cardiol 64:565-572, 2014