Title:Evidence-Based Percutaneous Closure of the Left Atrial Appendage in Patients with Atrial Fibrillation
Volume: 8
Issue: 1
Author(s): Silvio Leal, Raul Moreno, Manuel de Sousa Almeida, Jose Aniceto Silva and Jose L. Lopez- Sendon
Affiliation:
Keywords:
Atrial fibrillation, left atrial appendage, oral anticoagulation, percutaneous closure devices, stroke, THROMBOGENESIS, Atrial fibrillation, LAA, Cardioembolic stroke, non-anticoagulated patients
Abstract: Atrial fibrillation is the most common cardiac arrhythmia, and its prevalence is increasing. Cardioembolic
stroke, most of the times secondary to thrombus formation in the left atrial appendage, is its most feared and life threatening
consequence. Oral anticoagulation with vitamin-K-antagonists is currently the most used prophylaxis for stroke in patients
with atrial fibrillation; unfortunately, its benefits are limited by a narrow therapeutic window and an increased risk
for bleeding, making it often undesired. Percutaneous occlusion of the left atrial appendage is a novel alternative strategy
for cardioembolic stroke prophylaxis in patients with atrial fibrillation at a high risk of stroke but with contraindication for
long-term oral anticoagulation therapy. At present, several devices have been developed specifically for percutaneous occlusion
of the left atrial appendage. Current results show good feasibility and efficacy for these devices, with a high rate
of successful implantation, although also associated with the inherent potential periprocedural complications. This work
reviews the current state of the art of percutaneous left atrial appendage closure for stroke prophylaxis in patients with
atrial fibrillation.
