Letter from the Editor in Chief

DOI: 10.19102/icrm.2015.060601

MOUSSA MANSOUR, MD, FHRS, FACC

Editor-in-Chief

Dear Readers,

This issue of the Journal contains many interesting publications. I would like to highlight the article by Dr. Hu and colleagues entitled “Device-based Approach to Prevention of Stroke in Atrial Fibrillation”. In this article the authors review numerous catheter-based endocardial and epicardial left atrial appendage closure devices. These devices include the PLAATO, the Amplatzer Cardiac Plug (ACP) and Amulet (St. Jude Medical, St. Paul, MN), the Watchman (Boston Scientific, Natick, MA), the WaveCrest LAA Occluder (Coherex Medical, Salt Lake City, UT), the Transcatheter Patch (Custom Medical Devices, Athens, Greece), Occlutech (Helsingborg, Sweden), the Ultrasept LAA closure device (Cardia Inc., Eagan, MN), the LAmbre device (Lifetech Scientific Corp., Shenzhen, China), the AEGIS system, and the LARIAT system.The authors provide an elegant summary describing each device as well as data from clinical studies.

The article highlights two important facts in the field of catheter-based left atrial appendage closure. The first is the large number of devices that are currently used on a commercial or investigational basis. Ten different devices are described in the article. This large number of devices probably reflects the strong interest in mechanical stroke prevention in atrial fibrillation. Despite the availability of four novel anticoagulants, a large number of patients continue to present challenging clinical scenarios rendering the use of oral anticoagulants difficult. The second more important fact which is evident in this article is the paucity of data in this field. With the exception of the PROTECT AF and PREVAIL studies, there are no prospective randomized clinical studies to guide the use of these devices.

The development of catheter-based therapy for left atrial appendage closure represents a major step forward in the field of atrial fibrillation and stroke prevention. However this advance is significantly limited by the lack of data to guide the applications of these therapeutic interventions. A number of critical questions remain unanswered: How do the different devices compare to each other? How does endocardial left atrial closure compare to epicardial ligation? What is the optimal anticoagulation regimen post procedure? Designing prospective clinical studies to answer these questions and others is of utmost importance.

As always, I hope that you find this issue of the Journal beneficial to you and your practice. Best wishes for a relaxing summer.

Warm regards,

Editor-in-Chief

Moussa Mansour, MD, FHRS, FACC
Editor-in-Chief
The Journal of Innovations in Cardiac Rhythm Management
MMansour@InnovationsInCRM.com
Director, Cardiac Electrophysiology Laboratory
Director, Atrial Fibrillation Program
Massachusetts General Hospital
Boston, MA